Stinging for Science

ames Robinson reclines in a hospital bed, looking a tad anxious as allergist David Golden prepares an unusual syringe. Instead of containing a liquid medicine, the modified device—with a flat circle of wire mesh at the business end instead of a needle—holds a cold, stiff-moving yellow jacket, taken straight from a lab fridge.

Golden grasps the syringe tightly, warming the captive bee. He asks Robinson if he’s ready.

“Sure.” The sleeve of his gown rolled up, Robinson presents his forearm to the short doctor with the tall forehead, who wears a yarn bee as a lapel pin. Golden places the mesh end of the syringe on the tanned expanse of skin, then slowly pushes the plunger. Forced downward, the bee arches, getting madder. Robinson looks away, then back again, focusing on the black and yellow insect that’s about to deliver a sting for science.

The bee takes its time, crawling in a slow circle on Robinson’s arm. Golden eases the plunger onto the now-buzzing bee, trapping it.

“Owww!” Robinson’s body tenses, knees locked, head tossed back as the bee unloads its venom. The pain subsides quickly, and over the next hour Golden and several nurses will draw blood samples and monitor Robinson.

The payoff for such pain? Robinson gets $75 and—if he doesn’t suffer a severe allergic reaction—reassurance that he will not need costly venom immunotherapy, the only treatment for insect allergies.

Meanwhile, Golden gets more data to answer why people develop wildly varying allergic reactions to bee stings.

Twenty years ago, he and other Hopkins researchers recommended to Congress that insect immunotherapy, in the form of monthly or bimonthly shots, would save untold millions in emergency-room expenses for sting victims. Subsequently, allergists adopted the shots, which contained purified bee venom developed by Larry Lichtenstein at Hopkins, as standard therapy. That is, allergists generally recommend them to anyone who has had an allergic response to a bee sting, if they also showed a positive skin test (which uses a minute amount of venom).

But over the past few years, Golden began wondering if some people were receiving the shots unnecessarily. Earlier data showed that only 60 percent of people with a history of allergic reactions would have a reaction if stung again. What about the other 40 percent?

“I started thinking there must be low-risk groups that don’t need immunotherapy,” says Golden. “We could save a lot of money, time and swollen arms [from the shots] if we could find out exactly who is low risk. The clinical goal for the sting challenge, then, is to find out who needs treatment and who doesn’t.”

So after the twice-weekly stinging sessions, Golden and his staff sift through the blood samples, looking for anomalies between the strong reactors — who have system-wide and potentially dangerous reactions—and the mild reactors. They’ve found a few leads, like a molecule called histamine releasing factor, but Golden says it will take time, and volunteers, to discover differences in their immune systems. To this bee man, the pain-making work is well worth it.

“It is an imposing dilemma, but the answer will help people with insect as well as other allergies,” says Golden. “And who knows, we might even find an on/off switch for all allergies.”

Now calm after the sting, Robinson asks Golden, considered a leading expert on insect venom allergies, what happens to the bees afterward.

“We’ve had a number of volunteers who have personally requested to squash them,” says Golden. “But we give them back to the entomologist.” Golden must maintain good relations with his cross-town insect supplier—this year he plans to sting 200 volunteers like Robinson.

Robinson waxes philosophic, showing surprising aplomb for a man with 10 bee stings (the outdoor, spontaneous kind) on his medical chart. “They say all creatures have a place in nature. Why not just let them go?”

An hour later, Robinson is free to leave. Good news for him—he had only a small, local reaction to the sting. And for Golden, as Robinson will be back for another sting challenge, with a honeybee.

Besides, “that wasn’t so bad,” says Robinson. “Wasps hurt a lot more.”

— Brian Vastag