The big itch -- Tips for a scratch-free season

Some people are lucky enough to float through summer like a breeze with nary a bug landing on them, let alone biting them.

Then there are the rest of us; the ones who are as tasty as the all-you-can-eat buffet at Shady Maple.

Tired of scratching? To help you enjoy the rest of the season as itch-free as possible, we spoke with Steve Albrich, a physician assistant in the emergency department at Blue Mountain Health System.

Q. What should we do before heading outside to keep those bugs at bay?

"One thing you could do would be to apply bug repellent containing DEET," says Albrich. "It is supposed to be safe and effective, but there are those who prefer not to use it."

Although medical experts say it is safe for children over 2 months of age, Albrich recommends talking to your pediatrician before using it on children. And if you're not a fan of chemical bug repellent, there are other methods you could try before pulling out the big guns.

"I would wear light-colored clothing," Albrich says. "If it's really bad, or if you're walking in the woods, wear long-sleeved shirts and pants. Also avoid wearing perfume, lotions, aftershaves or a real potent shampoo. Those things are all going to attract bugs."

Albrich says he uses cedar oil when he heads outdoors.

"It's a natural bug repellent. If it's really bad, however, that's not going to work."

Q. Once we get bit, why do some people not exhibit any sign for several hours to a day later?

"I think it just has to do with immune systems. Some may have that atopic tendency to have more environmental allergies," says Albrich. "A lot of those people tend to have asthma as well. Your immune system is already set up to have a type 1 histamine mediated response. Those people are going to develop localized reactions more quickly, such as redness, swelling or an anaphylactic reaction."

It that reaction centers on the neck, lips or face, that can be concerning.

"If they come to the ER, we will give them an IV with IV steroids and Benadryl, and then observe for several hours for progressive symptoms, such as swelling of the tongue or airways," he says.

These types of reactions occur mostly with stings. It's not typical with mosquito bites, which usually result in just a localized reaction or infection.

Q. What should one do at the first sign of a bite?

"Remove yourself from the situation if there are a lot of them," says Albrich. "If there are any stingers left in the skin, remove them as they contain venom. Then apply an ice pack to the sting or bite areas."

Q. What about when that itching becomes unbearable?

Use ice packs for 20-30 minutes, every couple hours, says Albrich. Don't apply ice directly on the skin. Use Benadryl every few hours. Benadryl is weight-based, so read the back of the box for the proper dosage.

"You can also apply a topical hydrocortisone," says Albrich. "You can do all this together, ice, Benadryl, hydrocortisone."

Over-the-counter medications contain 1 percent hydrocortisone. If the itching is really bad, your doctor could write a prescription for a topical medicine containing 2.5 percent cortisone.

Q. What about homeopathic medications or old wive's tales? Does any of that work?

"Aveeno baths, calamine lotion. I tell people 'Look, if you know something, and your mom used to do it as a kid and it works, then by all means do it, as long as it's safe,'" he says. "Tylenol or ibuprofen may help with the swelling or pain."

Q. What about infections?

"Initially, in the first day or two, there may be some localized swelling or redness. If it spreads out further than a half dollar (or what seems unusual for you), it's indicative of an infection," says Albrich. "If it's more than that, or if it's expanding and increasing in pain and warmth, then see your doctor. Some people can be bitten by a fly and have a ton of redness or swelling."

Over 48 to 72 hours, the symptoms should begin to resolve. If they're progressing and getting worse, Albrich says you should see your doctor.

Q. How long should the itching last?

Up to five days, especially if there are multiple bites.

Q. When is it time to see a doctor?

"Definitely if the symptoms are increasing. If there is pain, swelling and redness at the sight, fever or chills, get to a doctor right away," says Albrich.

"If you get bit by anything, develop any sort of swelling of the head or neck, chest pain or shortness of breath, abdominal pain, nausea or vomiting, get right to an emergency room."

These types of reactions are mostly with wasps or yellow jackets.

"We can't always identify what it is, but any anaphylactic or allergic response are all treated the same way."