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PubMed1989

Late-onset allergic reactions, including serum sickness, after insect stings.

Allergic reactions after insect stings may have a delayed onset, differing from the usual immediate anaphylactic pattern. Ten patients, aged 6 to 78 years, had allergic reactions 1 to 2 weeks after an insect sting. Six patients had had multiple stings preceding the reaction. In two instances, immediate anaphylaxis also occurred. Four of the 10 patients had serum sickness-type reactions; two other patients had more severe anaphylactic symptoms, including throat edema. All patients in this group had venom-specific IgE; four of the 10 patients had serum venom-specific IgG. Eight patients subsequently received venom immunotherapy (VIT). There have been no reactions from seven re-stings. Five patients had generalized hives starting 6 to 24 hours after an insect sting. All patients in this group had venom-specific IgE; three patients have received VIT. Two other patients developed hives, one with throat edema 3 days after an insect sting. Both patients had high titers of serum venom-specific IgE; neither patient has received VIT, one patient because of extreme sensitivity. These observations suggest that after an insect sting, patients may develop delayed-onset allergic symptoms that range from typical anaphylaxis to serum sickness and are mediated by venom-specific IgE. VIT is recommended for patients with these reactions.

Adult↗
PubMed1992

Management of insect sting hypersensitivity.

Approximately 1 to 3% of the general population has had a systemic reaction to insect stings. Adults whose reactions include urticaria, obstruction of the upper or lower airway, or hypotension and children whose reactions include obstruction of the upper or lower airway or hypotension have an increased risk of future systemic reactions to stings. Allergy skin tests to Hymenoptera venoms can help to identify the offending insect and to classify the reactions as allergic; however, because 15% of the general population may have positive results to such tests, persons who have not experienced a systemic reaction to insect stings should not be tested. Venom immunotherapy is highly effective and confers 98 to 99% protection in patients who have experienced previous systemic reactions to insect stings. Reaction rates to venom skin tests or venom immunotherapy are low and are similar to those in allergy testing and immunotherapy for hay fever. Generally, patients who have had systemic reactions to stings should be assessed by an allergist to determine whether they are candidates for immunotherapy with Hymenoptera venom. The decision to institute venom immunotherapy should be based on the disposition of the patient, the severity of the reaction, and the risk of subsequent stings. Deliberate sting challenges are clinically useful for guiding immunotherapy.

Animals↗
PubMed2005

Natural history of large local and generalized cutaneous reactions to imported fire ant stings in children.

BACKGROUND: There are no published data on the natural history of large local and generalized cutaneous reactions to imported fire ant (IFA) stings in children. OBJECTIVE: To determine the natural history of large local and generalized cutaneous reactions to IFA stings in children not treated with immunotherapy by reviewing medical records from a venom clinic during the past 20 years. METHODS: Patients were selected for the study if they were 16 years or younger at the time of the reaction, had only cutaneous symptoms (generalized cutaneous or large local), and did not initiate immunotherapy. Each patient's parents were asked to recall whether the patient had experienced any further stings since the last evaluation at the venom clinic. RESULTS: We contacted 31 of 57 patients evaluated between July 10, 1984, and February 5, 2004. Twenty patients (65%) reported that they had not developed more severe reactions with subsequent stings. Reactions remained cutaneous only. Eleven patients (35%) had not been stung again since the original evaluation. Five of these patients had moved out of the IFA-endemic region. None of the previously evaluated patients reported subsequent life-threatening anaphylaxis from IFA stings. CONCLUSIONS: These limited data on IFA stings suggest a benign outcome in children 16 years and younger with large local or generalized cutaneous reactions. Larger and more extensive studies need to be conducted to further define the natural history of cutaneous reactions to IFA stings in children.

Adolescent↗
PubMed1996

Bee and wasp sting reactions in current beekeepers.

BACKGROUND: A majority of subjects allergic to bee venom are beekeepers, their relatives, or neighbors. Predetermining systemic reactivity to honeybee stings and risk assessment through laboratory tests have been unsatisfactory. OBJECTIVE: To estimate the prevalence and type of sting reactions, and especially to evaluate potential risk factors of systemic reactions in beekeepers. METHODS: A questionnaire concerning sting reactions and potential risk factors was mailed to all members of the regional beekeepers' association; 191 beekeepers were included in the study. RESULTS: Systemic bee sting reactions were present in 50 (26%) and large local reactions in 73 (38%) of the beekeepers. Similar reactions following wasp stings were present in 2% and 13%, respectively. Twenty-four (48%) of the systemic reactors and 39 (28%) of the remaining subjects had a history of atopic symptoms (allergic rhinitis, allergic bronchial asthma, or atopic dermatitis). While working at hives, nasal and eye symptoms were present in 54% of the systemic reactors and in 23% of the remaining subjects. Systemic reactors were younger and had been beekeepers for a shorter period than nonreactive subjects. Multiple logistic regression analysis showed that the risk of systemic sting reaction increased fourfold when nasal or eye symptoms were present while working at hives and twofold when the years in beekeeping were less than 15. CONCLUSIONS: The occurrence of systemic and large local reactions after bee stings is high among beekeepers. A history of atopy is associated with systemic reactions. Both the presence of nasal or eye symptoms while working at hives and a history of beekeeping less than 15 years significantly increase the risk of systemic reactions.

Adult↗
PubMed2003

Elevated basal serum tryptase and hymenoptera venom allergy: relation to severity of sting reactions and to safety and efficacy of venom immunotherapy.

BACKGROUND: Mastocytosis and/or elevated basal serum tryptase may be associated with severe anaphylaxis. OBJECTIVE: To analyse Hymenoptera venom-allergic patients with regard to basal tryptase in relation to the severity of sting reactions and the safety and efficacy of venom immunotherapy. METHODS: Basal serum tryptase was measured in 259 Hymenoptera venom-allergic patients (158 honey bee, 101 Vespula). In 161 of these (104 honey bee, 57 Vespula), a sting challenge was performed during venom immunotherapy. RESULTS: Nineteen of the 259 patients had an elevated basal serum tryptase. Evidence of cutaneous mastocytosis as documented by skin biopsy was present in 3 of 16 patients (18.8%). There was a clear correlation of basal serum tryptase to the grade of the initial allergic reaction (P<0.0005). Forty-one of the 161 sting challenged patients reacted to the challenge, 34 to a bee sting and 7 to a Vespula sting. Thereof, 10 had an elevated basal serum tryptase, i.e. 1 (2.9%) of the reacting and 2 (2.9%) of the non-reacting bee venom (BV) allergic individuals, as compared to 3 (42.9%) of the reacting and 4 (8%) of the non-reacting Vespula venom-allergic patients. Thus, there was a significant association between a reaction to the sting challenge and an elevated basal serum tryptase in Vespula (chi2=6.926, P<0.01), but not in BV-allergic patients. Systemic allergic side-effects to venom immunotherapy were observed in 13.9% of patients with normal and in 10% of those with elevated basal serum tryptase. CONCLUSIONS: An elevated basal serum tryptase as well as mastocytosis are risk factors for severe or even fatal shock reactions to Hymenoptera stings. Although the efficacy of venom immunotherapy in these patients is slightly reduced, most of them can be treated successfully. Based on currently available data, lifelong treatment has to be discussed in this situation.

Adolescent↗
PubMed2003

Investigational and clinical use of the sting challenge.

PURPOSE OF REVIEW: The sting challenge has been an important tool in advancing our knowledge about allergy to stings from insects in the order Hymenoptera. While some European centers have advocated its use in the past as a routine diagnostic procedure to select patients requiring venom immunotherapy, this practice has been abandoned because of the poor reproducibility of the test. In this review, the possible use of the sting challenge in clinical practice is discussed in the light of current knowledge of the limitations of the test. Its use in recent studies is also discussed, with an emphasis on the implications of the test's variability. RECENT FINDINGS: Several studies have attempted to quantify the risk of recurrence of anaphylactic reactions to hymenoptera stings under various clinical circumstances on the basis of the outcome of a single sting challenge. Many of these studies were carried out with small patient numbers, and consequently must be interpreted with caution. SUMMARY: While the sting challenge with a living insect is still the best available test for ascertaining clinical reactivity to insect venoms, the reproducibility of this procedure is modest. The outcome of single sting challenges in individual patients should therefore be interpreted with caution, in both the research setting and clinical practice.

Animals↗
PubMed2005

Avoidance of bee and wasp stings: an entomological perspective.

PURPOSE OF REVIEW: Clinicians and researchers in allergy and immunology are often unaware of aspects of stinging insect biology that would be of practical interest to their patients. This review discusses entomological literature pertaining to avoidance of bee and wasp stings, with emphasis on risk factors associated with provoking individual foragers versus disturbing colonies and preventive measures for both circumstances. RECENT FINDINGS: Recent work pertaining to sting avoidance has mostly been concerned with the development and testing of attractants, insecticides and delivery systems for toxic baiting programs to control vespine wasps. SUMMARY: Sting risks and avoidance measures associated with bee and wasp foragers are different from those posed by disturbing colonies. Despite widespread advice to the contrary, no evidence currently exists that wearing perfume or bright, floral-colored clothing elevates sting risk. Foragers usually have to be firmly touched before they will sting; therefore, personal protection largely involves guarding against accidental direct contact. Although still under development, the most effective means for reducing local populations of foraging vespine wasps are toxic baiting programs. Preventing stings from colonies is more problematic and depends mostly on personal awareness when disturbing vegetation. The most effective measure in mitigating the severity of a mass attack is probably the wearing of white or light-colored clothing.

Animals↗
PubMed1992

Management of a major box jellyfish (Chironex fleckeri) sting. Lessons from the first minutes and hours.

OBJECTIVE: To report the management of a serious box jellyfish (Chironex fleckeri) envenomation from the first minutes of bystander first aid and treatment by ambulance personnel to subsequent treatment in hospital. CLINICAL FEATURES: A 14-year-old girl sustained a serious Chironex fleckeri sting. There was no loss of consciousness, but the patient suffered severe pain, myocardial irritability, acute pulmonary oedema and mild systemic hypotension, due to the direct toxic effects of the venom. Thirst was a dominant symptom. INTERVENTION AND OUTCOME: Management involved rapid bystander action and call for ambulance assistance; and early intervention with oxygen/nitrous oxide administration, compression bandaging, antivenom administration and electrocardiographic monitoring at the site by ambulance personnel. Echocardiography in hospital three hours after the sting showed a normal myocardium. In hospital management resulted in recovery. Nocturnal itching of the sting persisted for six weeks. CONCLUSIONS: (i) Vinegar dousing may irritate freshly stung skin, but as a nematocyst inhibitor vinegar remains an essential part of the first aid treatment for cubozoan jellyfish stings. (ii) Compression/immobilisation bandaging was not associated with long-term harm to the sting area. (iii) The pain of an intramuscular antivenom injection may not be felt by a chirodropid sting victim, so safe injection protocols must be strictly observed. (iv) Ambulance services in other States whereas there is a risk of box jellyfish (Chironex fleckeri or Chiropsalmus quadrigatus) stings should be similarly trained and equipped to deal with serious jellyfish envenomations.

Acetates↗
PubMed2001

A case of jellyfish sting.

Jellyfish sting may result in a wide range of symptoms from common erythematous urticarial eruptions to the rare box-jelly induced acute respiratory failure. In Taiwan, with the increasing frequency of international travel, cases of jellyfish sting to foreigners are on the rise. We report a case of jellyfish sting with the rare presentation of painless contact dermatitis. A 38-y-o man accidentally stepped on a sea urchin with his right foot during scuba diving in a beach in Thailand. Traditional therapy with vinegar was applied on the lesion. However, when he returned to Taiwan, erythematous patches on the left thigh with linear radiations to the leg were discovered. The skin lesions had bizzare shapes and showed progressive change. No pain or numbness was noticed. Jellyfish stingwas suspected, topical medications were applied, and the patient recovered without complication. Jellyfish stings usually result in a painful erythematous eruption. In this case, though the lesion involved a large surface, there was no pain. Delayed diagnosis of jellyfish sting was due to the atypical presentation and the physician's unfamiliarity to the Thai jellyfish sting. Awareness to the wide spectrum of jellyfish sting symptoms should be promoted.

Adult↗
PubMed2003

Evaluation of scorpion stings: the poison center perspective.

Scorpion venom causes excessive adrenergic discharge and cardiotoxicity. Publications on scorpion stings using mainly admission data, has led to the belief that most scorpion stings are severe and mandate an observation period of at least 12 h regardless of symptomatology. We to assessed the characteristics of scorpion sting victims with emphasis on severity and time to presentation by retrospective poison center chart review of 225 calls over 12-mo. Thirteen percent of patients were asymptomatic and 72% and 15% were mild or moderately to severely ill, respectively. The most frequent manifestations were pain (97.3%), cardiovascular signs (23.1%) and ECG changes (13.7%). Ninety-four percent of the patients presented within 6 h; 86% within 3 h. Ninety-two percent of moderate to severe patients, including those with moderate to severe cardiotoxicity, presented within 3 h; 100% within 6 h. Clinical severity of the stings was greater in females than in males. No association was found between degree of severity and time to presentation and age. Most scorpion stings in Israel (at least those occurring in the north and central regions) are mild. The majority of envenomated patients present for medical assistance within 3 h including all patients with moderate to severe cardiotoxicity. Because of severity of potential complications, that scorpion sting victims should be observed in the emergency department for 6 h from the time of sting and should be admitted if symptoms other than local pain develop. Reduction of unnecessary in-hospital observation time is expected to save public health money.

Adolescent↗
PubMed1995

Deliberate hymenoptera sting challenge as a diagnostic tool in highly selected venom-allergic patients.

BACKGROUND: Open environment and working conditions close to abundant insects of the order Hymenoptera should be avoided as much as possible by patients allergic to Hymenoptera venom who do not receive venom immunotherapy. After having experienced accidental field re-stings not resulting in a systemic reaction, some of these patients may be willing to resume normal life and working habits. Since venom-specific IgE usually remains elevated in these patients, repeated skin tests or RASTs are not helpful in identifying disappearance of their venom allergy. OBJECTIVE: The purpose of this study was to evaluate the usefulness of deliberate live sting challenge as a diagnostic tool in highly selected venom-allergic patients who had initially refused venom immunotherapy. METHODS: Two cases are reported of bee venom-allergic patients who had previously refused venom immunotherapy and subsequently experienced honeybee field re-stings not resulting in systemic reactions. Two to three years later, their skin tests remained positive for bee venom. A third patient allergic to Vespa orientalis who had negative skin tests to all available venoms was denied venom immunotherapy due to lack of proper commercial venom. Because none of the patients was receiving venom immunotherapy the military service personnel concluded they still had venom allergy and rejected them from the highly prestigious service. All three patients were anxious to confirm the disappearance of their venom allergy and we used deliberate live sting challenges for that purpose. RESULTS: Two to three years after their initial systemic reactions live sting challenges were well tolerated by the three patients. They felt free to resume their normal life habits and were allowed to begin military service without further limitations. CONCLUSION: Deliberate insect stings using appropriate safety precautions should be considered a diagnostic tool in selected allergic patients who do not receive venom immunotherapy but in whom a reliable history of negative field re-stings can be obtained despite positive skin tests and in those who continue to have inconclusive venom skin tests.

Adolescent↗
PubMed1996

[Insect stings. A prospective study of complications and injury mechanisms].

The aim of the study was to evaluate complications to insect stings, and to describe the circumstances in which the patients were stung. During a one year period (1.1.-31.12.1991) a total of 178 hospital and emergency room contacts due to insect stings were registered. All patients afterwards received a mailed questionnaire concerning insect stings. Nearly 3/4 of the patients were able to identify the stinging insect by use of an identification chart. One hundred and forty-five patients had mild symptoms, 33 patients had moderate symptoms and three presented severe symptoms with anaphylactic shock. Eleven percent of the patients required admission and another 21% were seen in out-patient clinics. More children than adults could after a physical examination be discharged from the hospital without treatment. More than 3/4 of the stings occurred in July, August and September and more than 3/4 were during the day and evening. We found that most of the insect stings were due to either wasps or bees and that no one stung by insects other than wasps or bees needed admission to hospital. We conclude that a major part of insect stings could be avoided by following ordinary precautions.

Adolescent↗
PubMed2004

Randomized, paired comparison of No-Sting Barrier Film versus sorbolene cream (10% glycerine) skin care during postmastectomy irradiation.

PURPOSE: Postmastectomy irradiation provides an excellent model for irradiated skin care practices because of the relatively uniform surface and radiation compared with other situations in which radiation-induced moist desquamation is common. We designed a study to test the effect of prophylactic 3M Cavilon No-Sting Barrier Film (No-Sting) on the rates of moist desquamation compared with sorbolene cream (with 10% glycerin). METHODS AND MATERIALS: The irradiated chest wall was divided into medial and lateral halves. Sixty-one women were randomized to have No-Sting applied to either the medial or lateral half, with the alternate half treated with sorbolene. RESULTS: For all patients, the skin toxicity, calculated as the area under the curve, mean No-Sting and sorbolene score was 8.1 vs. 9.2, respectively (p = 0.005, Wilcoxon signed rank test). The total number of weeks of moist desquamation for the 61 patients was 40 vs. 45, equating to a mean of 0.65 week vs. 0.74 week per patient in the No-Sting and sorbolene-treated areas, respectively. The rates of moist desquamation were 33% vs. 46% (p = 0.096, McNemar's Exact test). For 58 fully assessable patients (minimum of 7 weekly observations), the area under the curve and rates of moist desquamation were significantly different statistically (p = 0.002 and 0.049, respectively). No statistically significant differences were noted in the pain scores. The pruritus scores were significantly reduced in the No-Sting area (area under the curve, p = 0.011). CONCLUSION: No-Sting reduces the duration and frequency of radiation-induced moist desquamation.

Adult↗
PubMed1991

Contact urticaria due to the common stinging nettle (Urtica dioica)--histological, ultrastructural and pharmacological studies.

A frequent cause of contact urticaria is skin exposure to the common stinging nettle (Urtica dioica). The urticaria is accompanied by a stinging sensation lasting longer than 12 h. Little is known of the cellular and molecular mechanism of stinging-nettle urticaria. After preliminary pharmacological analysis of pro-inflammatory activity in nettle stings, the cellular response of mononuclear cells, polymorphonuclear cells and mast cells was examined in six people 5 min and 12 h after nettle contact. Only mast cell numbers were significantly increased at 12 h. Ultrastructurally, some mast cells showed evidence of degranulation at 5 min and 12 h. At 12 h mast cells were closely associated with dermal dendritic cells and lymphocytes suggesting a functional unit. The mean histamine and serotonin contents of a nettle hair were found to be 6.1 ng and 33.25 pg, respectively. Nettle-sting extracts did not demonstrate histamine release from dispersed rat mast cells in vitro. These results suggest that part of the immediate reaction to nettle stings is due to histamine introduced by the nettle. However, the persistence of the stinging sensation might suggest the presence of substances in nettle fluid directly toxic to nerves or capable of secondary release of other mediators.

Blood Vessels↗
PubMed2025

STING inhibits LINE-1 retrotransposition through sorting ORF1p to lysosomes for degradation.

The cyclic dinucleotide sensor stimulator of interferon (IFN) genes (STING) is known for its critical role in interferon and inflammatory responses. In addition, STING also has functions independent of interferon induction. In this study, we report that STING restricts the mobilization of the cellular retrotransposon long interspersed nuclear element 1 (LINE-1) independent of cGAS and interferon induction. LINE-1 is the only active autonomous retrotransposable element in the human genome and its transposition can cause genetic and autoimmune diseases. STING inhibition of LINE-1 requires its dimerization. Mechanistically, STING interacts with LINE-1 ORF1p, then the complex translocates to the ER-Golgi intermediate compartment (ERGIC) and the Golgi followed by sorting to Rab7-positive lysosomes for degradation. Our data unveil a function of STING in maintaining host genome integrity by restricting LINE-1 retrotransposition via an IFN-independent mechanism.

Humans↗
PubMed2006

[Increasing incidence of wasp stings in otorhinolaryngological practice].

BACKGROUND: Wasp sting injuries can be lethal due to generalized reactions and edematous obstruction of the upper respiratory system. Due to media reports and our own observations, the consequences of the 2004 "plague of wasps" should be examined for the ear, nose, and throat (ENT) region. PATIENTS AND METHODS: Wasp sting injuries treated during the years 2002 to 2004 were evaluated in a retrospective study with respect to frequency, localization, therapy, occurrence of allergic reactions, and other complications. RESULTS: In 2002 to 2004, the number of patients with wasp sting injuries tripled. The occurrence of stings in the ENT region increased from 20% to more than 40%, with a strong rise in enoral and endolaryngeal stings after accidental swallowing or inhalation of wasps. The medical treatments employed proved the existence of sufficient therapeutic strategies. CONCLUSIONS: The treatments demonstrate a clear increase in wasp sting injuries in the year 2004. The main climatic cause was the European record summer of 2003, in which wasps multiplied.

Adolescent↗
PubMed1991

In-hospital sting challenge in insect venom-allergic patients after stopping venom immunotherapy.

Immunotherapy (IT) in venom-allergic patients has been demonstrated to provide a highly efficient protection from severe reactions to a re-sting. It is not known whether this protection will persist after IT is stopped in patients with remaining venom sensitivity. In 25 adult patients with a previous severe systemic reaction to a Hymenoptera insect sting, 28 in-hospital sting challenges after stopping IT resulted in no systemic reactions. The mean duration of venom IT was 42.8 months (range, 36 to 83 months), and the mean time interval from the time IT was stopped until sting challenge was, in mean, 25.2 months (range, 12 to 36 months). The mean venom-specific IgE after stopping IT was 2.4 PRU/ml (range, 0 to 16.9 PRU/ml), at the day of sting challenge, 2.7 PRU/ml (range, 0 to 22 PRU/ml), and 2 weeks later, 2.4 PRU/ml (range, 0.02 to 27.8 PRU/ml). These changes in IgE were not significant. Venom-specific IgG concentration when IT was stopped was 64 PU/ml (range, 20 to 144 PU/ml), decreasing significantly to the day of sting challenge to 41.1 PU/ml (range, 13 to 84 PU/ml), and 2 weeks later, a significant increase to a mean of 53.5 PU/ml (range, 12 to 117 PU/ml) was found. Our results suggest that venom IT may be stopped after 3 years, regardless of the level of specific antibodies. To confirm this finding, a larger number of patients should be studied.

Adult↗
PubMed1994

Lack of reproducibility of a single negative sting challenge response in the assessment of anaphylactic risk in patients with suspected yellow jacket hypersensitivity.

To investigate the reproducibility of a single negative response to sting challenge with a living insect, we rechallenged a group of 61 patients who showed no clinical response to a first sting challenge. All patients had previously had symptoms suggestive of anaphylaxis after a yellow jacket field sting. Thirteen patients (21%) had anaphylactic responses after the second sting challenge, and six of these patients had severe reactions including symptomatic hypotension requiring administration of Adrenalin. This rate was significantly lower than the response rate of the original patient group to a first sting challenge (39%). Thus although fewer positive responses were observed in patients who had had a previous negative challenge response, the number of anaphylactic reactions was considerable and included patients with potentially life-threatening symptoms. Consequently, a single sting challenge may not be used to select patients for venom immunotherapy.

Adolescent↗