Ask Your Pharmacist

June 19, 2019
Q:

My five-year-old daughter has fly bites around her eyes on her face. They are itchy and swollen. Is that normal? What should I do?

A:

Great question. Black flies, mosquitoes and other flying insects are coming out of the swamps and forests looking for a meal after thriving during our wet spring. Usually people experience some degree of itching, redness and swelling around the fly bite, but the severity of this depends on the person. Swelling around the bite site is generally considered normal and can be self treated at the local pharmacy. I suggest asking your pharmacist to assess the swelling and recommend options to help ditch the itch and bring down the swelling.

First though, wash the area to prevent infection. After that, applying a cold compress can help take down the itching and swelling. This is especially useful for sensitive areas, like around the eye, where you would not want to use an anti-itch cream (hydrocortisone, Benadryl cream, and Afterbite being some of the most popular). Typically for itching, swelling and redness in a small area, or a few bites, hydrocortisone applied two to three times daily for a few days (up to seven) is enough to provide relief and usually starts working within minutes.

If the bites are widespread or quite swollen, an oral antihistamine may be a better option as it reaches all areas of the body and does so quickly. Reactine, Claritin and Aerius are examples of second-generation antihistamines which are taken just once daily. Those have a very low risk of drowsiness and for this reason, they are a good first choice. They can easily be combined with cool compresses, or even hydrocortisone cream if needed for added itch control. Antihistamines such as Benadryl are also effective, but drowsiness can be a limiting side effect. Seniors should also lean towards second-generation antihistamines if an oral tab is needed; dizziness, drowsiness, and other side effects can be more pronounced in seniors which is the cause of several falls and hospital visits each year.

True anaphylaxis allergic reactions are rare, especially from flying insect bugs, but they are more common from stings and spider bites. Symptoms of anaphylaxis are swelling and rash, faint rapid heart beat, dizziness, fainting, and difficulty breathing. If you think you may be having an anaphylactic reaction, go to your local emergency room as soon as possible. If you’ve been prescribed an EpiPen, using it will give you time (about 30 minutes) to get to the hospital. Benadryl can also help in this situation. Anaphylaxis is an emergency so prompt identification is crucial.

Preventing bites before they happen should be the first plan. Sprays containing DEET are typically the first choice for preventing bug bites (including ticks) and can be used in all ages over six months old. DEET comes in strengths from five to 30 per cent, and the recommended strength used depends on age and how often it is able to be applied (five per cent DEET needs to be reapplied every 1.5-two hours while 30 per cent lasts five to eight hours). Apply the spray lightly to any exposed spin and the top of the clothing while avoiding the face and eyes. For children under six months, soybean oil can be used, but I recommend covering up and using a bug net to protect exposed skin. Icaridin is a DEET alternative (Pi Active, etc.) that is gaining popularity and can be used in those over six months old.

A wide array of products are available to prevent and treat bug bites and since everyone reacts differently to bug bites, ask your pharmacist to help pick out the product or treatment that would work best for you. If you do need an EpiPen, now is the time to check the expiry date to make sure it has not expired and is readily available in case of emergency.

Jared Mactavish (BSc., Pharm) is a pharmacist at Guardian Pharmacy in Hampton and St. Stephen. His opinions expressed in this newspaper are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.