Health Care

Allergy shots and EpiPens: living with a lethal fire ant allergy in the Lowcountry

Allergic to fire ants? This Hilton Head Island woman is

Eddy Hoyle, of Hilton Head Island, describes what happened the first time she was stung by fire ants and how she came to realize just how allergic she is to them.
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Eddy Hoyle, of Hilton Head Island, describes what happened the first time she was stung by fire ants and how she came to realize just how allergic she is to them.

She remembers being “engulfed in yellow,” and the buzzing.

Yellow jackets — all over her, in her nose and ears.

Her parents heard her scream.

Eddy Hoyle was just a child, 11 or 12 she thinks, when she was stung 101 times at Youghiogheny River Lake in her home state of Pennsylvania. Her parents had to throw her in a shower to get the insects off. She was taken to a country doctor and stayed in his care for a few days.

“ ‘Don’t get stung again,’ ” she said, recalling his advice decades later as she sat in the waiting room at Allergy and Asthma Center’s Hilton Head Island location. “He said when (you’re exposed to) that much venom, it could create an allergy.”

If you’re ever around a bee again, he told her, close your eyes, hold your breath and don’t move.

Hoyle, a Bluffton resident, has been carrying an EpiPen — a self-administered shot of epinephrine, used to counter allergic reactions — for more than 30 years.

She’s only had to use it once. She treated her reaction to bees, wasps and hornets before moving to the Lowcountry in 2002, but a few years later, while working in her garden, she discovered a new allergy.

A rare and lethal one — to fire ants.

He said when (you’re exposed to) that much venom, it could create an allergy.

Eddy Hoyle

Only about three percent of adults and less than one percent of children are thought to have “potentially life-threatening allergic reactions” to the venom of bee, wasp, yellow jacket, hornet and fire ant, according to the American College of Allergy, Asthma and Immunology. The Texas A&M University College of Agriculture and Life Sciences estimates around one percent of the population is “hypersensitive” to ant venom.

Thomas Beller, an allergist who treats Hoyle and others at the Allergy and Asthma Center, said he sees an average of only 30 fire-ant allergy cases a year in Beaufort and Jasper counties.

Half of his cases are those with “large, local reactions” — “dramatic swelling” where the fire ant sting occurs.

The other half involve “systemic reactions,” where a sting on the ankle will, for instance, trigger swelling in the throat. And half of those cases — about a quarter of his total caseload — involve reactions “you could call life-threatening.”

Nationally, at least 40 people die every year from insect stings, according to the The American College of Allergy.

In 2009, Sun City Hilton Head resident Janet Wallace Roedl Shiansky had a fatal reaction to a fire ant sting she suffered while gardening.

A year earlier, Hoyle had her first encounter with fire ants and almost suffered a similar fate.

She’d just stood up from her weeding on that summer day when she spotted one she’d missed, near a rose bush. She bent over to pull it, and, when she lifted the weed, noticed the ants swarming on her arm. They stung. She frantically brushed them off. Her arm felt like it was on fire.

 ‘Man, I need to put some ice on this,’ ” she said, remembering the last coherent thought she had before walking through the front door and passing out on the floor.

Later, when she came to, after the paramedics had treated her, she learned she’d somehow managed to crawl to the back of the house — knocking over a couch and vomiting along the way — where she injected herself with an EpiPen and called 911.

“I don’t remember any of it,” she said, adding that her husband was out playing golf at the time.

I don’t remember any of it.

Eddy Hoyle

After a second sting — from just a single ant hiding in her bag — a couple months later, she passed out again. Again, her husband wasn’t home. She decided to visit Beller’s office.

Where she learned her “fire ant allergies were off the charts.”

She started an immunotherapy treatment plan, which Beller and the American Academy of Allergy, Asthma & Immunology (AAAAI) describe as allergy shots containing small doses of the allergen that help a patient build up natural immunity. It’s usually a five-year plan, Beller said, with the first year — the most expensive with more frequent shots — costing about $800, depending on the patient’s insurance. In subsequent years, a patient gets one shot a month, he said, and annually pays about $300.

Because her allergy is so severe, Hoyle still gets monthly shots even though she’s past the five-year treatment mark.

“You’re not born with allergies,” Beller said. “You can’t become allergic to something until you’re exposed to it. So, for example, you can’t react to your first sting until your body looks at the venom and says, ‘There’s something about this venom I don’t like.’ ”

When the body discovers it doesn’t like the venom, the immune system produces antibodies called immunoglobulin (IgE), Beller said. Those antibodies cause the allergic reaction.

The reaction, in Hoyle’s case, was anaphylaxis, the symptoms of which might include itching, hives, swelling in the throat or tongue, difficulty breathing, dizziness, stomach cramps, nausea and diarrhea, according to the AAAAI. “In extreme cases,” the organization said, “a rapid fall in blood pressure may result in shock and loss of consciousness.”

It’s not atypical, Beller said, for someone to not have a reaction to their first sting, then have a severe reaction to their second. And the potential for an anaphylactic reaction is greater if the person’s first exposure was to a large amount of venom.

These days, Hoyle stashes an EpiPen in her purse, her car and her desk drawer at work. She sprays her feet with Deet. When she gardens she wears gloves that cover to the elbow and rubber boots that rise to the knee.

She recently donned those boots for a beach wedding, hiding them under her sundress.

“I’m not going to stop living my life because of my little nemesis,” she said, joking that she wouldn’t mind if tawny crazy ants — an invasive species on the Lowcountry’s doorstep that is resistent to fire ant venom — eradicated the source of her allergen.

“I think people need to take all allergies seriously,” she said. “You never know — what might not bother you today can be lethal tomorrow.”

When she was a child, after she’d be stung 101 times by the yellow jackets at the lake, she visited a horse stable where a territorial bee started to buzz her. Other people panicked and ran from the stable.

But Hoyle remained.

She closed her eyes. Held her breath. Didn’t move.

The bee left her alone.

“All’s well that ends well,” she said.

Wade Livingston: 843-706-8153, @WadeGLivingston

Fire-ant allergy facts

▪  Out of the roughly 30 cases allergist Thomas Beller sees a year, about 20 of those are Marine recruits from Marine Corps Recruit Depot Parris Island. According to Marine Corps spokesperson Capt. Greg Carroll, a “life-threatening (fire ant) allergy, as determined by a medical professional,” will disqualify a recruit from continuing his or her training.

▪  Fire ants are so small that the venom used to make allergy shots is collected by mashing the ants into a solution — “whole-body extract,” in Beller’s words. Bee allergies used to be treated with whole-body extract, he said, but allergists discovered it didn’t work; bees were too large and, proportionally, didn’t have enough venom.

▪  Allergy shots “build up a tolerance” to an allergen, Beller said. During the early stages of immunotherapy, when patients are being exposed to an increasing amount of venom, there is a risk of allergic reaction to the shot. That risk decreases over time, when the doses level out. Still, patients have to bring an EpiPen with them when they get a shot, and they can’t immediately leave, just in case they suffer a reaction.

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