Carpentersville fire Battalion Chief Todd Middendorf’s death was brought on by anaphylactic shock after being stung by bees, according to a medical examiner’s report.
The report, obtained by The Courier-News from the Knox County Regional Forensic Center through a Freedom of Information Act request, notes authorities in Sevier County received a 911 call on July 16 concerning Middendorf, 46. Middendorf died July 18 at Fort Sanders Regional Medical Center in Knoxville, Tenn., in Knox County. The report lists the cause of death as “anaphylaxis due to bee sting.”
The Middendorfs have a home in the Sevierville, Tenn., area, where friends said the family intended to retire. The family was on vacation there last month at the time of the incident that led to Middendorf’s death.
Middendorf became employed as a firefighter in Carpentersville 23 years ago, after working for two years with the department in Hazel Green, Wis. He lived in Carpentersville, worked his way up to the rank of battalion chief and was based at Station 1 on Spring Street at the time of his death.
Middendorf was well-respected by his fellow firefighters in Carpentersville and surrounding communities. His wake and funeral services July 27 drew a large number of people to St. Mary Catholic Church in Huntley.
Knox County Chief Deputy Medical Examiner Dr. Christopher Lochmuller, an associate professor of pathology with the University of Tennessee Graduate School of Medicine, said this summer the center has seen two or three cases, including Middendorf’s, involving anaphylactic shock and stings. Lochmuller said he couldn’t recall a single similar case in his seven years at the Knox County Regional Forensic Center.
“It would be rare,” Lochmuller said. “They are few and far between.”
Carpentersville Village President John Skillman, the village’s former fire chief, was a good friend of Middendorf’s. He said that with bee or wasp stings, “We found out recently that if you don’t have a severe allergic reaction one time, down the line you might. The next time, you just don’t know.”
What happened to his friend could happen to anyone, Skillman said. He likened it to anaphylactic shock reactions from eating shellfish, where there have been cases involving people who formerly had no problem eating such but developed allergies later in life.
Skillman said he talked with Middendorf’s widow, Daisy, who told him she was not ready to discuss what happened to her husband.
Severe allergic reactions to insect stings or bites are not seen on a regular basis but are not uncommon, said Dr. Mohammad Zaman, who oversees the emergency department at Elgin’s Presence St. Joseph Hospital.
Zaman said the hospital’s ER did have one case recently of a man who headed to an immediate care facility, where he said he was stung by a bee. The man was sent to the ER to be treated for anaphylaxis.
Dr. Farheen Mirza, an allergist and immunologist at Northwestern Medicine Central DuPage Hospital, said that such cases are seen from time to time and that deaths are very rare.
According to statistics provided by Elgin’s Advocate Sherman Hospital, from January 2016 to Aug. 15, 2017, that hospital’s ER had 116 patients who were seen for “toxic effect of venom of bees.”
Dr. Noga Askenazi is with the Advanced Allergy & Asthma Associates/Food Allergy Center of Illinois, which has one of its three offices in Elgin. She is a past president of the Illinois Society of Allergy, Asthma and Immunology. The practice’s website, www.myallergydr.com, notes that anaphylaxis is a severe and sudden allergic reaction which needs to be treated immediately.
“Shortly after exposure to an allergy trigger, a series of reactions occur in the body, causing blood vessels to expand temporarily. This, in turn, lowers blood pressure and may cause fainting (and can lead to death). Hives or swelling may appear, commonly on the throat and face, and the patient may have difficulty swallowing, talking, or breathing,” the site states.
Askenazi said an allergic reaction to an insect sting or bite can develop at any age, even if someone had been stung before and had no adverse reaction. Such allergies can develop at any age.
Hymenoptera is the insect order that can sting and contains venom, Askenazi said.
The insects most commonly causing this condition are honeybees, hornets, yellow jackets, fire ants and wasps, Askenazi said, with the most common allergy being to yellow jackets, which are the most aggressive hymenoptera.
Someone can be allergic to one, some or all of the various insects’ venoms, Askenazi said.
Deaths from anaphylactic shock brought on by insect stings or bites are extremely rare, Askenazi said.
“There are only about 50 such deaths a year across the entire United States,” Askenazi said.
The strongest correlation to having an allergic reaction to stings is having a history of having such reactions, Askenazi said.
And a key is getting help as soon as possible, as anaphylaxis can happen within five to 20 minutes or up to two hours later, depending on the person and the details of the stinging incident.
Immediate treatment for reactions involves receiving a dose of epinephrine from an injection such as Auvi-Q, Epipen or a generic, then antihistamines and steroids. As Skillman noted, ambulances for fire departments in the Elgin area and many elsewhere have Epipens along with Benadryl or a similar antihistamine.