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PubMed1987

Prazosin for vasodilator treatment of acute pulmonary oedema due to scorpion sting.

Prazosin hydrochloride, a post-synaptic alpha receptor blocking agent, was administered to twelve patients with acute pulmonary oedema due to scorpion sting in order to lower their mean blood pressure (diastolic blood pressure plus one-third of pulse pressure) 10 to 20 mmHg. Following an oral dose (0.125 mg in children and 0.5 mg in adults), clinical improvement was seen in the form of disappearance of apical systolic murmur and pulmonary oedema, a reduction in heart rate observed at the end of the first hour, and maximal improvement seen at the end of the third hour. Chest radiographs showed conspicuous clearing of pulmonary oedema. Electrocardiographs (ECG) showed hypoxic injury patterns such as a Q-wave in lead I and AVL with tented T waves in precordial leads, left anterior hemiblock (LAHB) and acute infarction patterns with subsequent T-wave inversion. The severity of clinical signs and ECG changes increased as the time between the sting and attending hospital lengthened.

Acute Disease↗
PubMed1976

Stinging insect allergy: changing concepts.

Immunologic advances promise changes in the approach to diagnosis and treatment of Hymenoptera stings. Results of skin tests with venom show good correlation with those of in vitro tests (histamine release and radio-allergosorbent test [RAST]). Similar comparisons of whole-body extract (WBE) skin tests with in vitro tests show poor correlation. Treatment emphasis must currently be placed on sting prevention and on medical treatment. The only material now available commercially for immunotherapy is WBE. Circumstantial evidence suggests some benefit from immunotherapy with WBE, but immunologic data do not support this observation.

Adult↗
PubMed1990

Stings and bites. Tips on coexisting comfortably with the insects.

Many stings and bites can be prevented if an individual has some knowledge of insect behavior. However, persons known to be allergic to insect stings should carry an epinephrine injection kit to use as a first aid measure. Those who travel far from medical facilities should additionally carry prednisone and oral antihistamines. The bite of a brown recluse spider may cause a minor reaction or it may evolve into extensive soft-tissue necrosis with a potentially fatal outcome. If necrosis occurs, a course of oral dapsone is recommended.

Animals↗
PubMed1991

Scorpion sting in children in the Jerusalem area: a review of 54 cases.

Fifty-four children from the Jerusalem area were studied prospectively following scorpion envenoming. Their ages ranged from 11 months to 10 years. Severe symptoms (convulsions, brain oedema, shock, respiratory distress and myocarditis) were encountered in 19. Respiratory distress was the main feature in 17 of the children, in two cases owing to pulmonary oedema and in a third because of adult respiratory distress syndrome and myocarditis; mechanical ventilation was required in three cases. The severity of the symptoms and signs was not related to sex, age, weight, interval between scorpion sting and admission or to the type of offending scorpion; it was most likely dependent upon the susceptibility of the individual and/or the dose of venom injected by the scorpion. Intravenous antivenom quickly reversed the symptoms, and no side-effects were seen in the patients studied. The two patients who died had not received the antivenom intravenously. We recommend that specific antivenom should be given intravenously in all children who show significant symptoms. Furthermore, a longer period of observation is necessary following scorpion sting in this age group.

Animals↗
PubMed1991

Intracranial haemorrhages after Nebo hierochonticus scorpion sting.

A 3-year-old boy, who was previously well, developed acute pulmonary oedema, fundal haemorrhages, temporary blindness and deafness following a Nebo hierochonticus scorpion sting. Cranial CT scan 8 days after admission showed bilaterally symmetrical multiple hyperdense areas with intense enhancement in the cerebellar and cerebral hemispheres consistent with multiple haemorrhages. He made a complete clinical recovery with resorption of the retinal haemorrhages 4 weeks after the scorpion sting. Cranial CT scan 8 months later revealed the intracranial lesions to be hypodense with no contrast enhancement, indicating resorption of the haemorrhages.

Animals↗
PubMed1995

Chronic relapsing pancreatitis from a scorpion sting in Trinidad.

Chronic relapsing pancreatitis is a rare cause of abdominal pain in children and exceptionally rarely is related to a scorpion sting. We describe a 13-year-old girl who, following envenoming by a scorpion, developed recurrent attacks of sharp, intermittent pain in the umbilical region associated with fever, nausea, anorexia and vomiting, and changes in her psychological behaviour. Thorough clinical evaluation, including CT scanning, disclosed unabated pancreatitis. A modified Puestow procedure was performed with very good results. Physicians should be aware that in chronic relapsing pancreatitis, particularly in children, a scorpion sting should be considered an aetiological possibility.

Abdominal Pain↗
PubMed1994

Acute and delayed cerebral infarction after wasp sting anaphylaxis.

A 52-year-old man developed a severe anaphylactic reaction after a wasp sting. Slurred speech and left hemiparesis were noted a few hours later. Three-and-one-half weeks later, he became acutely obtunded and quadriparetic. Angiographic studies demonstrated complete and near-complete occlusions of the right and left internal carotid arteries, respectively. A mechanism is suggested for delayed ischemic stroke after wasp sting anaphylaxis that involves cerebrovascular sympathetic innervation.

Acute Disease↗
PubMed1981

Nephrotic syndrome developing after bee stings.

We have described a case, with renal biopsy findings and serologic studies, of a patient who had the nephrotic syndrome after sustaining multiple bee stings and who demonstrated a favorable response to steroid therapy. Bee stings have previously been implicated in the development of this syndrome, though the reported cases in the literature are poorly documented.

Adult↗
PubMed1995

Multiple fire ant stings indoors.

The progressive spread and increasing colony density of imported fire ants throughout the southeastern United States will result in increasing numbers of individuals with untoward reactions to the stings of these insects. In order to alert physicians that imported fire ant colonies may exist within homes and other inhabited dwellings and result in multiple stings to the occupants and to provide information about the management of this problem, we report two cases where individuals were stung indoors by imported fire ants. One of these cases involved the attack of a bed-bound patient by a colony of ants. The other report documents the establishment of an intact fire ant colony within an inhabited dwelling. Physicians should become familiar with the biology of these insects to assist patients in dealing with this problem.

Adult↗
PubMed2004

Hand-foot syndrome in a patient with multiple fire ant stings.

The case is reported of an elderly patient with known previous exposure to fire ant stings, and who presented with hand-foot syndrome (HFS) in the setting of multiple fire ant stings to the lower extremities. Both hands and both feet were red, swollen, and mildly tender. Treatment was with fluocinonide cream, and all symptoms resolved as the classic fire ant skin lesions regressed. HFS was initially reported in association with acute crisis in sickle cell anemia and thalassemia and more recently as a common toxicity of chemotherapy administration. This is the first report of its occurrence in the setting of fire ant envenomization. Although recent literature may indicate a potential therapeutic benefit from COX-2 antagonists, the process appears to be self-limited, and requires only conservative treatment.

Aged↗
PubMed2001

Stinging ants.

Ants belong to the order Hymenoptera, along with bees, wasps, yellow jackets, etc., they are the most successful animal genera in this world. It is their selfless social structure which accounts for their huge impact. Their effect on man ranges from the parasol ant, which makes plant cultivation untenable in certain parts of South America, to Solenopsis Invicta in the southeastern United States of America, which kill ground dwelling birds and small animals, harass livestock, and renders farmland unusable. With the exception of the Bulldog Ant of Australia (which is the size of a medium cockroach) direct toxic effects are not a lethal threat to man. Human fatalities and morbidity are related to secondary infections of excoriated stings or allergic anaphylaxis. This article reviews history and recent developments regarding stinging ants around the world.

Adult↗
PubMed2004

Diagnostic methods for insect sting allergy.

PURPOSE OF REVIEW: This review overviews advances from mid-2002 to the present in the validation and performance methods used in the diagnosis of Hymenoptera venom-induced immediate-type hypersensitivity. RECENT FINDINGS: The general diagnostic algorithm for insect sting allergy is initially discussed with an examination of the AAAAI's 2003 revised practice parameter guidelines. Changes as a result of a greater recognition of skin test negative systemic reactors include repeat analysis of all testing and acceptance of serology as a complementary diagnostic test to the skin test. Original data examining concordance of venom-specific IgE results produced by the second-generation Pharmacia CAP System with the Johns Hopkins University radioallergosorbent test are presented. Diagnostic performance of honeybee venom-specific IgE assays used in clinical laboratories in North America is discussed using data from the Diagnostic Allergy Proficiency Survey conducted by the College of American Pathologists. Validity of venom-specific IgE antibody in postmortem blood specimens is demonstrated. The utility of alternative in-vivo (provocation) and in-vitro (basophil-based) diagnostic testing methods is critiqued. SUMMARY: This overview supports the following conclusions. Improved practice parameter guidelines include serology and skin test as complementary in supporting a positive clinical history during the diagnostic process. Data are provided which support the analytical performance of commercially available venom-specific IgE antibody serology-based assays. Intentional sting challenge in-vivo provocation, in-vitro basophil flow cytometry (CD63, CD203c) based assays, and in-vitro basophil histamine and sulfidoleukotriene release assays have their utility in the study of difficult diagnostic cases, but their use will remain as supplementary, secondary diagnostic tests.

Animals↗
PubMed2006

Corneal bee sting-induced endothelial changes.

PURPOSE: To report the acute management and clinical findings of a case of corneal bee sting and to report the outcome of corneal endothelial cell analysis 1 year after trauma. METHODS: Clinical findings, anterior segment photographs, corneal endothelial images, and medical treatment of a case of right corneal bee sting are presented. Right and left central corneal endothelial cell analysis was performed by noncontact specular microscopy. RESULTS: The stinger was removed from the cornea. Systemic, subconjunctival, and topical steroids and systemic and topical antibiotics were given. One year later, a corneal scar and anterior capsular opacity of the lens in the right eye were shown by slit-lamp examination. Endothelial cell analysis determined that the endothelial cell density of the right eye was substantially decreased compared with the left eye. CONCLUSION: Corneal infiltration gradually decreased, presumably because of the systemic, topical, and subconjunctival steroids. Late complications observed in this case included a substantial decrease in cornea endothelial cell density, a corneal scar, and anterior capsular opacity.

Adult↗
PubMed1994

Foreign-body granuloma and IgE-pseudolymphoma after multiple bee stings.

We report a patient with an unusual combination of an eosinophilic foreign-body granuloma and a pseudolymphoma, with recurrent severe oedema on the forehead, after multiple bee stings. On immunohistology the foreign-body granuloma and lymphoid follicles reacted with monoclonal antibodies against the high- and low-affinity IgE receptors, and against IgE. Prick and intradermal tests with whole-body bee extracts showed positive immediate-type reactions. The eosinophilic granuloma formation and lymphoid follicles may have been induced by a combination of immune complex and cell-mediated hypersensitivity following antigen persistence. Although bee stings are common, as far as we are aware, this complex reaction pattern has not been reported previously.

Animals↗
PubMed1983

Venom-specific IgE and IgG antibodies as a measure of the degree of protection in insect-sting-sensitive patients.

Venom-specific IgE and IgG antibodies were measured in the sera of bee-venom-sensitive patients during a 3-year hyposensitization period. The level of specific IgG antibodies initially increased, and 2 months after the start of therapy, this increase was on average five-fold. A concomitant but non-significant increase in specific IgE antibodies was also observed initially. Later during the treatment period specific IgE antibodies showed a continuous decline and after 3 years the level was one third of the pre-treatment level. Venom-specific IgG antibodies, however, remained above the pre-treatment level. The disappearance of the severe allergic reactions was related to the level of both IgE and IgG antibodies as demonstrated in seventy-six bee sting challenges. In patients with specific IgG antibody levels above 400 u/ml, no severe reactions were observed even if the patient had levels of specific IgE antibodies of RAST class 3 or 4. These data suggest that the relationship between venom-specific IgE and IgG antibodies permits an evaluation of the state of immunity to insect stings.

Adolescent↗
PubMed1986

Sub-class of IgG anti-bee venom antibody produced during bee venom immunotherapy and its relationship to long-term protection from bee stings and following termination of venom immunotherapy.

The IgG sub-class antibody response to bee venom in the four sub-classes was investigated in ten patients during and after venom immunotherapy. All patients tolerated a bee sting challenge 1, 2 and 3 years after the start of treatment as well as 1 and 2 years after treatment was stopped. Anti-phospholipase A2 (PLA2) antibodies were of IgG1 and IgG4 sub-class and rose early in treatment, IgG1 anti-PLA2 fell to pre-treatment levels after 3 years in contrast to IgG4 anti-PLA2 levels, which remained high during maintenance therapy and declined relatively little in the 2 years after the termination of treatment. This data shows that IgG4 antibodies are maintained in the absence of monthly maintenance injections and suggests that they may provide long lasting clinical protection from insect stings.

Adolescent↗
PubMed2006

Pustular dermatosis caused by fire ant (Solenopsis invicta) stings in a dog.

This paper reports a case of spontaneous fire ant sting dermatitis in canine. The skin lesions consisted of nonfollicular, grouped pustules in the abdominal region. Several fire ants were found attached to the lesional skin. Histopathological findings included an intraepidermal neutrophilic pustule and predominantly neutrophilic interstitial dermatitis. An extensive area of collagen degeneration was also observed below the epidermal pustule. These clinical and histopathological findings are remarkable similar to those observed in fire ant stings in humans.

Animals↗
PubMed1978

Use of RAST technique in wasp sting hypersensitivity. Cross-reactions between various insect antigens are specially considered.

Clinical hypersensitivity to wasp stings was found to be fairly well correlated with the presence of serum IgE-antibodies against yellow jacket venom as detected by the RAST technique. Such antibodies were never found in a control group of non-allergic blood donors, but they were detected in a surprisingly large proportion of patients with bee sting allergy without known allergic reactions to wasps. Studies using RAST inhibition technique failed to prove cross-reactions between bee and wasp venoms. Considerably better results were obtained when venom antigens instead of whole body antigens were used in the RAST. RAST inhibition studies suggested that IgE-antibodies detected with RAST using whole body antigen are directed against bee venom constituents in the whole body extract.

Antibodies↗