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Prevention and primary care treatment of stings from imported fire ants.

Stings from imported fire ants constitute a problem encountered more and more frequently in practice settings across the Southern United States. Envenomation (impregnation of venom) in children is especially common. Current medical regimens for the treatment of other stinging insects are of little value in preventing local cutaneous reactions to fire-ant stings. The pathogenesis of reactions from imported-fire-ant stings is discussed, and suggestions for prevention, treatment and patient education are provided.

Aged↗

Stinging insect hypersensitivity in children.

In the past two decades, many advances have been made in the treatment of patients with insect venom sensitivity. An effective treatment (venom immunotherapy) has been developed and indications for therapy refined. In the past year, reports concerning fatal toxic reactions to multiple stings, Africanized ("killer") bees, bumblebee venom allergy and treatment, and reactions to fire ant stings have been published. Papers have also appeared on the use of sting challenges in the diagnostic evaluation of insect sting allergy, laboratory investigations of the mechanism of action of venom immunotherapy, and the outcome of discontinuing venom treatment after 5 years in insect-allergic patients.

Animals↗

Allergic reactions to insect stings and bites.

Insect stings are an important cause of anaphylaxis. Anaphylaxis can also occur from insect bites but is less common. Insect venoms contain several well-characterized allergens that can trigger anaphylactic reactions. Effective methods to diagnose insect sting allergy and assess risk of future sting reactions have been developed. Management strategies using insect avoidance measures, self-injectable epinephrine, and allergen immunotherapy are very effective in reducing insect-allergic patients' risk of reaction from future stings. Diagnostic and management strategies for patients allergic to insect bites are less developed.

Anaphylaxis↗

Anaphylactic reactions to Hymenoptera stings in asthmatic patients.

We evaluated 587 cases with generalized reactions to stings of Hymenoptera. Eighty of these patients and twenty-eight normal controls had radioallergosorbent tests (RAST) to venoms of honey bee, yellow jacket, hornet, wasp and to phospholipase A. Those patients with systemic reactions had a significantly greater frequency of positive RAST than normal controls (51.3% vs. 7.1%, P < 0.001). The frequency of atopy (asthma/rhinitis) in case these 587 cases was only 22% and resembled the expected frequency in a general population. Asthmatic patients did not have an increased risk of developing systemic reactions to Hymenoptera stings. However, those asthmatic patients with systemic reactions to Hymenoptera stings had a significantly more severe anaphylactic reaction to a sting than non-asthmatics. These severe reactions were primarily manifested by acute dyspnoea, which appeared to represent a bronchospastic response to endogenous histamine release.

Anaphylaxis↗

Insect sting anaphylaxis in patients without detectable serum venom-specific IgE.

Following insect sting anaphylaxis, twenty-five patients of over 500 evaluated, did not have detectable serum venom-specific IgE. Twenty-two were evaluated within 1 year of the reaction, fifteen within 6 months. Anaphylaxis occurred in six patients after their first sting exposure. The clinical features of the sting reaction were typical of the reaction occurring in insect-allergic patients with serum venom-specific IgE. Eleven of the twenty-five patients had negative venom skin tests. These observations suggest that a non-IgE mechanism may be responsible for a minority of insect sting reactions.

Adolescent↗

Allergy to venom from bee or wasp: the relation between clinical and immunological reactions to insect stings.

Sixty-three patients, applying to the casualty ward after a bee or wasp sting, were tested. On the day of admission, and 4 weeks later, blood was sampled to measure specific IgE and IgG against bee and wasp venom and total IgE. Four weeks after the insect sting, all patients were examined with skin-prick test (1, 10 and 100 micrograms/ml), and intracutaneous test (0.05 ml of extract 1.0 microgram/ml). The amount of venom-specific IgE and IgG increased significantly during the 4-week period, venom-specific IgE was most pronounced in patients experiencing the most severe clinical reactions. However, no significant correlations were found between the results of the immunological tests carried out 4 weeks after the insect sting and the clinical reaction upon the insect sting.

Animals↗

Histamine-releasing serum factors as a predictor of the outcome of insect sting reactions. Results from a multicentre study.

Cord blood cells were incubated (passively sensitized) with sera from 27 patients with previous systemic reactions to insect stings. Histamine release (HR) from these cells was measured following exposure to venom extracts at increasing concentrations. The aim was to see whether this parameter could predict more efficiently than RAST and skin test the outcome of a subsequent re-sting. Results showed that HR from passively sensitized cells tended to reflect skin sensitivity and specific IgE levels. If patients were not re-stung during the follow-up period, HR from the passively sensitized cells frequently decreased whereas an increase was seen (in 6/13) when using sera collected after re-sting. In conclusion HR from passively sensitized cord blood cells could not satisfactorily predict re-sting reactions in the serum donors.

Fetal Blood↗

Prevalence and clinical relevance of specific immunoglobulin E to pollen caused by sting- induced specific immunoglobulin E to cross-reacting carbohydrate determinants in Hymenoptera venoms.

BACKGROUND: Hymenoptera stings can induce specific IgE (sIgE) to carbohydrate determinants (CD) on venom glycoproteins that cross-react with CD in pollen. sIgE to such cross-reacting CD (CCD) are believed to have little or no biological activity and thus may cause misdiagnosis of pollen sensitization after a sting. OBJECTIVE: To determine the prevalence of multiple false positive CAP results to pollen because of sting induced anti-CCD sIgE in Hymenoptera venom (HV) allergic patients and to investigate the association of such anti-CCD sIgE with features of 'atopy'. METHODS: Skin prick tests (SPT) and CAP tests with grass, tree and weed pollen and with house dust mite (HDM) were carried out prospectively in 259 HV allergic patients and CAP tests with honeybee (HBV) and yellow jacket (YJV) venom were performed. Patients with negative pollen SPT associated with positive CAP tests to all three pollen groups were operationally defined as 'CCD positive'. We investigated in selected 'CCD positive' patients the presence of anti-CCD sIgE by CAP tests with bromelain and studied the identity of CD in HVs and pollen by mutual sIgE inhibition tests with CD from proteinase treated HBV (HBV-CD) and Lolium perenne (Lol-CD) extracts. RESULTS: sIgE to all three pollen groups without positive SPT or history was found in 16% of 259 patients. The presence of anti-CCD sIgE was substantiated by positive CAP tests with bromelain in 14/14 and by inhibition of all pollen CAP tests with HBV-CD in 8/9 and with Lol-CD in 2/2 patients. Double venom (DV) positive CAP tests were present in 93% of 'CCD positive' patients and were in some associated with DV skin test positivity and allergy. The prevalence of 'CCD positivity' was significantly higher among HBV (23%) than among YJV (11%) allergic patients, but was also unexpectedly high among those with DV allergy (47%). 'CCD positive' patients were younger, had a higher total IgE and more sIgE to HDM than 'CCD negative' patients. CONCLUSION: We have shown that the risk in HV allergic patients for misdiagnosis of multivalent pollen sensitization is 16%, and we have confirmed that sting induced anti-pollen sIgE are directed to similar CD in venoms and pollen. We found evidence that the recognition of CCD might be related to the 'atopic' trait. Importantly, a positive bromelain CAP test does not exclude clinical reactivity to both venoms in 'CCD positive' HV allergic patients.

Adolescent↗

Insect sting reactions to bees, wasps, and ants.

Abstract Arthropod bites and stings are capable of inflicting injury, inciting allergic reactions, and transmitting systemic disease. Members of the Hymenoptera order are of particular importance because they are nearly ubiquitous in nature, and their stings may cause life-threatening allergic reactions. Stings from bees, wasps, and ants produce a variety of clinical and histological manifestations. Anaphylaxis following an insect sting is the most serious complication. For individuals with a specific allergy to Hymenoptera venom, immunotherapy may be a relatively safe and effective treatment option.

Animals↗

The renin-angiotensin system in patients with repeated anaphylactic reactions during hymenoptera venom hyposensitization and sting challenge.

Patients with a history of anaphylactic reactions to hymenoptera venom who tolerated the hyposensitization and the sting provocation without problems (n = 10) had angiotensin I (ANG I), angiotensin II (ANG II), angiotensinogen and renin similar to the values found in healthy nonallergic controls (n = 11). In contrast, patients who repeatedly experienced anaphylactic reactions during hyposensitization and who displayed anaphylactic reactions to sting provocation with a living insect (n = 6) showed significantly lower renin (p < 0.05), angiotensinogen (p < 0.05), ANG I (p < 0.05) and ANG II (p < 0.05) plasma levels as compared to healthy nonallergic controls (n = 11). Sting provocation with a living insect induced clinical symptoms of anaphylaxis in all of the 6 patients. A decrease in ANG I was found in 4 of the patients (67%) after provocation as compared to the concentration before the sting challenge. Angiotensinogen decreased in 3 of the patients (50%) whereas renin activity decreased in 2 of the patients (29%). In all cases a decrease in ANG II was noticed (100%). It is concluded that patients at high risk of developing anaphylactic reactions possess a dysfunctional renin-angiotensin system (RAS) which is not stimulated and does not respond appropriately. These findings point to an important role of the RAS as a defense mechanism in response to anaphylactic reactions.

Adolescent↗

Acute polyradiculoneuropathy occurring after hymenoptera stings: a clinical case study.

Hymenoptera stings may be responsible for both local and systemic reactions; these can be immediate or delayed, depending on the time between the sting and the development of signs or symptoms. Delayed clinical reactions have been reported, although unusual, due to serum sickness and/or affecting organs or systems generally not involved in the immediate reaction, such as heart, kidneys, central and peripheral nervous systems. This paper describes the clinical and immunological findings in a 51-year-old subject, who, after two stings of paper wasps, the second one after the third venom immunotherapy (VIT) injection, presented immediate large local and systemic allergic reactions which quickly improved after e.v. methylprednisolone administration. About 40 hours later, he developed acute polyradiculoneuropathy with muscle weakness, paresthesia, difficulties in standing up and walking. Skin tests and specific IgE determination showed allergy to paper wasp. The activation, by wasp venom, of peripheral blood mononuclear cells in primary culture, evaluated by tritiated thymidine incorporation proliferation assay, showed an important hypersensitivity to wasp venom. Therefore our results suggest the hypothesis that the polyradiculoneuritis causative etiopathogenetic mechanism might be a delayed immunological response to wasp antigens followed by an allergy-triggered autoimmune reaction, as previously suggested by other authors; they found lymphocytic infiltrates in demyelinization areas and at perivascular levels, by histologic examination of autoptical and bioptical material of patients with nervous system lesions after hymenoptera stings.

Acute Disease↗

Skin and soft tissue necrosis following hymenoptera sting.

BACKGROUND: All kinds of bees, wasps, and hornets are members of the hymenoptera order. Local hypersensitivity reactions after bee stings are very common and well studied. However, tissue necroses following untreated bee stings are extremely rare and they are not well documented. OBJECTIVE: Two extremely rare cases of extensive skin and soft tissue necrosis following hymenoptera stings are presented. Current literature and treatment options are discussed. CONCLUSIONS: Local skin reactions following bee stings may result in severe complications such as tissue necrosis if left untreated. Skin grafting following surgical debridement is an adequate and practical treatment modality for such cases.

Aged↗

Bee sting of the cornea: a case study and review of the literature.

Bee stings of the cornea are rarely reported, but have the potential for causing serious ophthalmological injuries. We present a case of corneal bee sting with retained stinger apparatus. A 35-year-old patient presented with an acute, corneal bee sting of the right eye 12 hours after he was stung. The patient suffered from pain, blurred vision, and epiphora. The right eye showed edema of the upper and lower eyelid, conjunctival hyperemia, chemosis, and striate keratitis of the paracentral cornea by biomicroscopic examination. The stinger was identified in the depth of the corneal infiltration. Visual acuity was 5/10. It was removed surgically. After 2 months, the eye only showed a minimal residual corneal opacification. Visual acuity was 10/10. We present a case of bee sting to the cornea with retained stinger apparatus and treatment of this unusual presentation.

Adult↗

Eye injury after jellyfish sting in temperate Australia.

Although jellyfish stings are an uncommon medical problem in temperate Australia, significant morbidity can occur, particularly in association with infestations of large numbers of jellyfish in public swimming areas. We report a case of a jellyfish sting-related eye injury, probably caused by the "hair" jellyfish (Cyanea capillata) from southeast Australia. The patient, a 54-year-old man, was stung while swimming without goggles in a jellyfish-infested bay. He experienced severe pain in his right eye, requiring narcotic analgesia, and had decreased visual acuity associated with right-sided facial swelling. Although usually brief and self-limiting, eye injuries after jellyfish stings should be assessed and treated as early as possible to reduce the risk of longer term sequelae. Water safety campaigns should incorporate information on the prevention and early treatment of such stings.

Animals↗

A review of venomous animal bites and stings in pregnant patients.

This is a review of Medline and PubMed articles on venomous animal bites and stings during pregnancy reported in English literature from 1966 to 2002. Eighty-five venomous snakebites were reported in pregnant women. Although there are frequent anecdotal reports of scorpion stings in pregnant women, few case reports are documented. Other venomous animal bites or stings to pregnant women that have been reported include spiders, jellyfish, and insects, and these are described. Adverse reproductive and teratogenic effects of venoms on gravid animals are also briefly reviewed. Although uncommon, venomous bites and stings during pregnancy may have significant adverse effects on the fetus and the mother.

Animals↗

[Demographic and spatial aspects of scorpion stings in the northwest region of Belo Horizonte City, Minas Gerais, 1993-1996].

This paper analyzes a total of 352 scorpion sting reports in the Northwest quarter of Belo Horizonte, Minas Gerais. Traditionally, this area has shown one of the highest case incidence rates, and the present study pointed to 10.37 stings per 10,000 inhabitants. No gender preference was observed, but most victims were 50 years of age or older. Likewise, no relationship was observed between seasonality and sting rates. According to geographic distribution analyses, the highest incidence rates were in areas with the largest scorpion populations. This preliminary descriptive evaluation is important for guidelines to prevent scorpion stings, which should obviously consider local epidemiological features.

Adolescent↗

Epidemiology of allergy to insect venoms and stings.

Stings by bees, yellow jackets, hornets or wasps may cause allergic reactions in sensitized individuals, including systemic or anaphylactic reactions. The epidemiology and natural history of insect venom allergy is emerging in the past decade and has clarified the reasons for the false perceptions that whole body extracts of the insects were considered effective for therapy. Up to 3% of adults have had a systemic sting reaction but 25% show venom sensitivity on skin test or RAST. Sensitization is common after a sting but is transient in 50% of cases. The risk (and pattern) of systemic reaction differs in children, but is 50% for those with positive history and skin test. Lower risk of reaction is expected in those with positive skin tests and large local reactions (5-10%), no previous reaction (10-20%), children with strictly cutaneous generalized reaction (1-10%), or for those with no stings for over ten years (15-25%). These observations have profound impact on the evaluation of patients for initiation or discontinuation of venom immunotherapy.

Arthropod Venoms↗

Urine protein excretion after Hymenoptera sting.

The urinary excretion of albumin was measured on 7 consecutive days after a bee or wasp sting in 20 healthy persons, using a semiquantitative immunochemical chromatographic procedure (Micral stick). The mean albumin excretion was 11.1 +/- 15.0 (SD) mg/l. This was not significantly different from the findings in a control group of 17 volunteers with no history of bee or wasp sting (mean 8.7 +/- 17.4 mg/l). Pathologic albumin excretion (50-100 mg/l) was found in three of the sting group, with mean 37.2 +/- 23.7 mg/l. After 2 more months the urinary albumin excretion had normalized in two of the three, with mean 19.3 +/- 16.0 mg/l. Nephrotic syndrome did not occur. Reactions to the sting corresponded to 1-4 on the Müller scale, but were not correlated to albumin excretion.

Adolescent↗