An integral part of coping with allergic emergencies is their prevention. Regarding stinging insects, the following information should be helpful. It has been prepared by the American Academy of Allergy and is excerpted with the academy’s permission. Obvi­ously, people who are allergic to bees, hornets, wasps, or yellow jackets should do everything practicable to avoid being stung. The chance of being stung can be lessened by taking the simple precau­tions described in the following paragraphs. Preventive methods at home Food attracts the Hymenoptera (bees, hornets, wasps, and yellow jackets), as do outdoor cooking and eating, feeding pets outdoors, and partially filled garbage cans. Even dribble from a child’s popsiscle will attract insects. Keeping food covered until the moment of disposal, meticulous cleanliness about garbage areas, and the occasional spraying of patio and garbage cans with insecticides will contribute to keeping insects away. Gardening should be done cautiously. Cutting the grass with a scythe or sling blade, running a power mower over an underground yellow jacket nest, penetrating a bumble bee’s nest with a trowel, and clipping a hedge are all risky activities for people sensitive to insect stings. Finally, vines that can conceal nests or hives should be re­moved. Personal methods of prevention Perfume, hairspray, hair tonic, suntan lotion, and many other cosmetics attract insects. Loose cloth­ing in which insects might become trapped, bright colors, flowery prints, and the color black should all be avoided. Light colors—for example, white, green, tan, and khaki—are not considered attractive or antagonistic to bees. Any object, no matter how lightly it is touched, should be checked first for bees, hornets, wasps, or yellow jackets. Children should be taught not to pick up a wagon handle (or any toy, for that matter) without first looking for an insect on it. For instance, idly kicking a rotted log can send vibrations into the ground that disturb nearby yellow jackets. Public trash cans should be avoided. An insecticide bomb kept in a car’s glove compartment may be used when a stray insect flies in. Shoes or sneakers should be worn at all times when one is outdoors. Even hard beach sand should be suspect; one type of wasp spends most of its life on dune grass. Sandals do not provide adequate protection. Immediate removal of a stinger The honeybee is the only insect that leaves its stinger (with venom sac attached) in the victim. Be­cause it takes two to three minutes for all the venom to be injected, quick removal of the stinger and the sac will prevent much of the poison’s harmful effect. This is done with one swift scrape of the fingernail. The sac should not be picked up between thumb and forefinger; that merely squeezes in more venom. Hornets, wasps, and yellow jackets do not lose their stinger and should be brushed off promptly. Although some Hymenoptera are more combative than others, any insect will sting if its hive is disturbed. Thus, while it is important to destroy hives and nests, this should never be done by or in the presence of someone who is allergic to Hymenoptera. Instead, a hive or nest should be removed by an exterminator or at least by someone not allergic to stings. Nests and their removal Wasps build open-comb nests under eaves, behind shutters, in carports, shrubs, and woodpiles —in fact, almost any place that is protected. Nests can be destroyed by hosing, carefully knocking them down with a stick or broom handle, or scraping them into a jar (which should then be covered quickly). The area should be sprayed with an insecticide once daily for two to three days to discourage rebuilding at the same site. Jet sprays can reach twelve to fifteen feet. Yellow jackets build in the ground and emerge through a small hole, which should be marked during the day with a thin stick. At dusk, when all the insects have returned for the night, a liberal amount of gasoline, lye, or kerosene should be poured into the hole. Do not light the gasoline or kerosene, though. This procedure should be repeated the next evening to make sure the fumes have thoroughly penetrated the holes. A water hose should never be pointed at the hole; that will merely cause the insects to attack the person holding the hose. Hornets build a gray hive shaped like a football, usually in a shrub or high in a tree. If you can’t reach the nest with a flame or trap the insects in a jar, bucket, or metal drum, a pest exterminator or the fire department should be called in. Whether swarming on a twig or nesting in a hollow tree, honeybees may be removed by following one or more of the methods described above. They can also be removed by a beekeeper, who is frequently glad to acquire another colony. When a nest is out of reach, help from the fire department or a county agent of the Department of Agriculture should be considered. In conclusion, the allergic person should use common sense —keep calm and act quickly, avoid situations in which insects have been known to attack, and keep a sharp lookout when outdoors.

Abbreviated SRS-A, this substance is a chemical that is released during an allergic reaction. It is a powerful bronchial constrictor and probably plays an important role in the bronchospasm associated with asthma.

Any food can cause an allergenic reaction, but such foods as tree nuts, peanuts, shellfish, chocolate, and strawberries are more often allergenic than others. The excessive ingestion of a food sometimes creates sensitivity to that food. Thus, Scandinavians are most com­monly allergic to fish, the Japanese to rice. In the American diet, frequently eaten, and thus frequently allergenic, foods include milk, eggs, wheat, gluten, corn, and soya. A person allergic to one food is frequently allergic to related foods. For example, peanuts belong to the legume family, and people allergic to them often cannot eat peas and beans. They are not necessarily allergic, however, to all nuts, which fall into eleven different botanical families. By the same token, patients allergic to wheat are often allergic to other grains, but not necessarily to buckwheat, part of a different botanical family. Potatoes are related to tomatoes, but not to sweet potatoes. The following chart, which also includes many garden and medic­inal plants in common usage, indicates the botanical families to which various occasionally allergenic food substances belong.

Extrinsic asthma is a seasonal form of asthma caused by allergens found in the environment.

Gamma globulins are a restricted group of pro­teins obtained by the electrophoretic separation of serum proteins. Included are all the immunoglobulins that possess specific antibody activity against many foreign substances and are important in defense mechanisms against these substances. Commercial preparations of gamma globulins are available for treating patients with severe defi­ciencies in antibody production, as well as for treating those with certain diseases.

Cromolyn sodium (Intal) is the only bischromone drug now li­censed by the Food and Drug Administration. It is available as a powder in capsule form. Using a special device called a Spin-Haler, the capsule is punctured and the powder is inhaled into the lungs. Xanthone, another bischromone, is an experimental preparation for oral administration and is not licensed in the United States. Side Effects and Precautions Side effects of bischromones occur infrequently. Throat irritation, hoarseness, coughing, and wheezing are the most common. Nausea, vomiting, and dizziness also occur occasionally. Coughing and wheez­ing often can be prevented by the administration of an aerosolized adrenergic bronchodilator before using cromolyn. Serious but rare side effects are: swelling similar to that of hives under the skin (angioedema); hives; other rashes, allergic reactions involving more than one organ; allergic pneumonia (inflammation of the lungs); gastroenteritis (inflammation of the stomach and intestines); poly­myositis (inflamed muscles); and pericarditis (inflammation of the heart covering) . These effects subside, however, when use of the drug is discontinued. The safety of cromolyn when used during pregnancy has not been determined. Studies in animals indicate decreased fetal weight when an animal is given a dose that produces a toxic effect in the mother; but no tumor-producing effect has been reported, even when enor­mous doses were given intravenously during pregnancy. Potential damaging effects on human fetuses are not known. Expectorants Uses Expectorants promote the removal of mucus from the respiratory tract. They are used in treating asthma and chronic obstructive lung diseases such as chronic bronchitis, emphysema, and bronchiectasis. The last disease named is a condition in which dilatations similar to sacs chronically form in the lungs’ air passages. Representative Drugs The most widely used expectorants are guaifenesin (glyceril guaia-colate, Robitussin, 2/G, and Glycotuss) and iodides (Potassium Io­dide USP and Organidin). Water is still the most effective expectorant, however. Evidence of the effectiveness of other agents is insufficient to justify their use as expectorants; these agents are: ammonium chloride, ipecac, guaiacolsulfonate potassium, and terpin hydrate.

Allergy could indeed be causing you to lose your sense of smell. If all other possible causes have been eliminated, an allergic survey is needed. This survey, which may include skin tests, may be able to identify the external substances to which you are allergic. It is possible that a specific treatment will be prescribed, based on the information turned up by the survey.

Cromolyn sodium is the generic name for a medi­cation used to treat asthma; it is marketed under the brand name Intal and is given in the form of an inhaled powder.

Kapok is a vegetable fiber from the kapok tree. It was once widely used as stuffing for pillows, mattresses, sleeping bags, and cushions. Its allergenicity appears to be associated with aging of the fibers. In recent years, it has largely been replaced by synthetic materials.

is administered intravenously to ensure that the dose reaches the appropriate blood levels.