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PubMed1991

Human fatalities caused by wasp and bee stings in Sweden.

Bee and wasp stings represent an uncommon cause of death. In a retrospective study of all fatalities due to venomous animals in Sweden during a 10-year-period, we found 19 fatalities due to wasps, 1 due to bees but none due to snake bite. This gives an annual incidence of 0.2 per million inhabitants. Most of the deceased were older than 50 years and had an underlying cardiovascular disease while previous severe reactions after insect stings were uncommon. The number of stings was not a factor of importance. Symptoms and death occurred within minutes after the sting. The autopsy findings were in most cases non-specific. Although uncommon, the possibility of a fatal insect sting should be considered in unwitnessed deaths occurring outdoors in summertime.

Adult↗
PubMed1980

Clinical and immunologic studies of patients with large local reactions following insect stings.

During the summer of 1978, 22 patients who had large local reactions following insect stings were evaluated for the development of potential systemic sensitivity. Approximately half the patients had venom IgE antibodies, detected by either the immediate skin test or radioallergosorbent test (RAST). A control group of 26 patients experiencing normal sting reactions had only a 15% incidence of venom-specific IgE. No correlations could be found between the presence of venom-specific IgE and age, sex, sting location, atopic history, or prior stings. IgE antibodies were found in 13 of 17 patients who had experienced local reactions lasting more than 48 hr. Serum venom-specific IgG was detected in only three of 19 patients. These results suggest that following large local reactions from insect stings patients must be individually assessed for the presence of venom-specific IgE and consideration for specific immunotherapy.

Adolescent↗
PubMed1983

Demonstration of IgE and IgG antibodies against venoms in the blood of victims of fatal sting anaphylaxis.

Nine people died from insect sting anaphylaxis in North Carolina from 1979 to 1981. Postmortem blood specimens from eight of these subjects were analyzed for IgE and IgG antibodies against venoms. All eight were RAST positive to at least one of the venoms. IgE and IgG anti-venom levels were comparable to those of a group of untreated sting-allergic individuals. RAST to venoms was also performed on several control groups of sera and from 3% to 50% positive RAST results were found. The highest incidence was in rural North Carolina outdoor workers. The incidence of positive RAST results in the sting-death group was significantly different from that in the control groups. This is the first demonstration of IgE antibodies against venoms in the sera of victims of fatal anaphylaxis from stings and adds further evidence for the role of IgE in sting anaphylaxis.

Adult↗
PubMed1989

Clinical and immunologic features and subsequent course of patients with severe insect-sting anaphylaxis.

One hundred fifty-eight patients were evaluated because of symptoms of potentially fatal venom anaphylaxis, as defined by hypotension, including loss of consciousness (LOC), throat/laryngeal edema, or marked respiratory distress. The demographic characteristics were 118 male and 40 female patients; age range, 3 to 80 years; mean, 29.7 years; 33 patients less than 10 years; and incidence of atopy, 20%. One hundred twenty-seven patients had had prior stings; 27 had prior systemic reactions (SR), including one with LOC. Almost all patients had venom-specific IgE; RAST titers covered a wide range. As compared to the total group, the subset of 45 patients with LOC were older, had an increased incidence of cardiac disease and beta-blocker use, stings in the head area, and re-sting reactions in patients who did not receive venom immunotherapy (VIT). One hundred six re-stings occurred in 37 patients receiving VIT with no SR. There were 38 re-stings in 18 patients who refused VIT, with 14 SRs in 11 patients. These studies suggest no distinguishing characteristics, including age, that would identify patients susceptible to severe venom anaphylaxis and confirm the prophylactic effectiveness of VIT.

Adolescent↗
PubMed1991

Honeybee venom allergy: results of a sting challenge 1 year after stopping successful venom immunotherapy in 86 patients.

In 86 patients with a history of severe systemic reactions (SRs) to honeybee stings confirmed by a positive skin test and/or RAST to honeybee venom (HBV), immunotherapy (IT) with HBV was stopped after 3 to 10 years. All patients had tolerated well a honeybee sting during IT and were resubmitted to a sting 1 year after VIT was stopped. At the latter time, 15 patients (17%) developed an SR and 71 did not. There was no difference between the two groups regarding age, sex, IT duration, severity of the SR before treatment, as well as diagnostic tests with HBV (skin tests, RAST, and specific IgG) before the challenge. Patients with a relapse of their allergy had, however, developed allergic SRs to IT injections more frequently than patients with lasting protection (p less than 0.001). SRs to the sting challenge (CH) after IT was stopped occurred more frequently in those patients in whom efficacy of IT had previously been confirmed by lacking responses to a field sting than in patients who had tolerated an intentional CH during the injection period (p less than 0.025). Indeed, the incidence of relapse after venom IT was stopped was only 9.6% in patients who had previously tolerated an intentional CH. It is concluded that well-tolerated HBV IT may be stopped after at least 3 years, provided its efficacy has been documented by a CH without SR.

Adolescent↗
PubMed1994

Deliberate bee sting challenge of patients receiving maintenance venom immunotherapy at 3-month intervals.

BACKGROUND: A large part of the cost and inconvenience associated with venom immunotherapy (VIT) is related to the need for monthly treatments. Since VIT is advocated for at least 3 to 5 years, and occasionally longer, reducing the number of venom injections may cut down significantly on both cost and inconvenience. OBJECTIVE: We evaluated whether maintenance VIT given every 3 months is both safe and effective regarding reactions to treatment injections or field re-stings and lack of systemic reaction (SR) to deliberate challenge sting. METHODS: The standard 1-month interval was gradually extended to 3 months in 28 patients (mean age 26 years, range 7 to 76) allergic to bee venom (BV), yellow jacket venom, or both venoms. Nineteen patients allergic to BV were deliberately challenged by a live bee sting. In 15 patients the original SR in the field was moderate; in one patient it was mild; and in three patients it was severe. RESULTS: Mean duration receiving standard maintenance VIT before extending the 1-month interval was 17 months. No patient had an SR while receiving the 3-month VIT therapy. Two patients experienced four field re-stings while receiving the 3-month therapy with no reaction. After the live challenge, there was mild urticaria in a single patient; no SR developed in the rest of the patients. CONCLUSION: For young patients allergic to BV whose initial SR is mild to moderate and who have already received 1-month VIT for longer than 17 months, the maintenance interval may safely be extended to 3 months while preserving its protective activity against re-stings.

Adolescent↗
PubMed1997

Hymenoptera sting anaphylaxis and urticaria pigmentosa: clinical findings and results of venom immunotherapy in ten patients.

BACKGROUND: Occasional patients with urticaria pigmentosa and anaphylaxis after Hymenoptera stings have been described. In this situation the question arises: Is anaphylaxis IgE-mediated or induced by pharmacologic mediator release from mast cells? METHODS: We investigated 10 patients with histologically confirmed urticaria pigmentosa and a history of anaphylaxis after honeybee or Vespula stings before and during immunotherapy with the respective venom. RESULTS: In eight of 10 patients, an elevated serum tryptase level was found. In two of 10 patients, no venom-specific IgE could be detected by either skin tests or RAST. Five patients had no detectable venom-specific serum IgE, and in the remaining patients the level was low (<1 Phadebas RAST unit). Venom immunotherapy was well tolerated and caused only one mild systemic reaction in a patient during the dose increase phase. Six patients were re-stung while receiving venom immunotherapy: only one had a mild systemic reaction (angioedema) after a Vespula sting. CONCLUSION: Anaphylactic symptoms after Hymenoptera stings in patients with urticaria pigmentosa are most often IgE-mediated but can occasionally be observed in the absence of IgE sensitization to venom allergens. Venom immunotherapy can be safely and successfully used in patients with urticaria pigmentosa and sting anaphylaxis.

Adult↗
PubMed1987

Meat tenderizer in the acute treatment of imported fire ant stings.

Meat tenderizer containing the proteolytic enzyme papain was tested for therapeutic efficacy in the sting of the imported fire ant. The parameters of pain and itching were used to evaluate qualitatively the sting response in 22 healthy medical students, and the laser Doppler velocimeter was used to assess quantitatively the change in cutaneous blood flow. The results indicated that, during the acute-phase reaction, no clinically or statistically significant difference was found between stings treated with meat tenderizer and stings treated without tenderizer. Therefore we conclude that meat tenderizer is of no therapeutic value in the acute treatment of the imported fire ant sting.

Animals↗
PubMed2001

Venomous fish stings in tropical northern Australia.

Venomous fish stings are a common environment hazard worldwide. This study investigated the clinical effects and treatment of venomous fish stings. A prospective observational case series of patients presenting with venomous fish stings was conducted in tropical northern Australia. Twenty-two fish stings were included; subjects were 3 females and 19 males; mean age 35 (range 10-63). 9 by stingrays, 8 by catfish, 1 by a stonefish, 1 by a silver scat (Selenotocota multifasciata), and 3 by unknown fish. All patients had severe pain, but less commonly erythema, 3 cases (14%); swelling, 7 cases (33%); bleeding, 5 cases (24%); numbness, 4 cases (19%); and radiating pain, 3 cases (14%). Mild systemic effects occurred in one stingray injury. Treatment included hot water immersion, which was completely effective in 73% of cases, analgesia, wound exploration and prophylactic antibiotics. Stingray injuries should be explored and debrided with large wounds, while other stings only need appropriate cleaning. The routine use of antibiotics is not recommended.

Adolescent↗
PubMed2005

Predicting scorpion sting incidence in an endemic region using climatological variables.

Scorpionism is a public health problem in several regions of the world. The highest mortality, with over 1000 deaths per year, has been reported in Mexico. We analysed the significance of climatological variables to predict the incidence of scorpion stings in humans in the state of Colima (Mexico) for the years 2000-2001. The pluvial precipitation (mm), the evaporation (mm), and the mean, maximum, and minimum temperatures (degrees C) were obtained from local meteorological offices. There are approximately 3 stings/year per 1000 people in municipalities of Colima and Villa de Alvarez and about 18-30 stings/year per 1000 people in the rest of the municipalities. There is very little rain and there are few stings in the winter when the minimum temperature is below about 16 degrees C. The number of scorpion stings is independent of the actual rainfall when this is above 30 mm/month. Using multiple linear regression, we used a backward model selection procedure to estimate that the minimum temperature is correlated with scorpion sting incidence with a statistically significance of 95%. We briefly discuss the application of predictive models of scorpion sting incidence in the appropriate allocation of antivenom serum in hospital clinics.

Animals↗
PubMed1998

Fatal anaphylaxis due to fire ant stings.

Imported fire ants (Solenopsis invicta and Solenopsis richteri) are the source of a potentially lethal environmental hazard in the southeastern United States. Because of their resistance to natural and chemical control, fire ants can overwhelm their environment, causing destruction of land and animals. Fire ants can also cause a variety of health problems in humans, ranging from simple stings to anaphylaxis and death. We present a case of a 30-year-old woman who died of anaphylaxis following multiple fire ant stings. At autopsy, multiple skin lesions characteristic of those produced by fire ant stings were present on her arm. Postmortem blood samples were positive for imported fire ant venom-specific IgE antibodies (5654 ng/ml) and tryptase (12 ng/ml). Deaths caused by imported fire ant stings are rare but are likely to become more common as the fire ant population expands. In this report, we review deaths due to fire ant stings, discuss postmortem laboratory findings, and stress the importance of recognizing the characteristic skin lesions produced by fire ants.

Adult↗
PubMed2006

Anaphylaxis to bull dog ant and jumper ant stings around Perth, Western Australia.

OBJECTIVE: To determine the main causative species, reaction characteristics and geographical locations of ant sting anaphylaxis around Perth, Western Australia (WA). METHODS: Structured interviews were performed on a cohort of 10 patients referred to our Anaphylaxis Clinic who were allergic to ant venom, followed by field trips to collect ant specimens. A descriptive analysis of clinical data was performed. RESULTS: Around Perth, Myrmecia gratiosa, a bull dog ant, was the only species of stinging ant found around the locations where reactions had occurred (eight patients). To the south-west of Perth, species implicated were another bull dog ant Myrmecia nigriscapa (one patient), and a jumper ant Myrmecia ludlowi (one patient). Twelve reactions were documented as mild (one), moderate (seven) and severe with hypotension (four). In three bull dog ant venom allergic patients, specific IgE was analysed, demonstrating substantial cross-reactivity with other bull dog ant species. Clinical patterns of reaction severity and response to repeated stings were consistent with known features of insect sting allergy. CONCLUSIONS: A single species of bull dog ant, M. gratiosa, appears to be responsible for ant sting anaphylaxis around Perth. Further investigation is required for other regions of WA. The provision of effective immunotherapies for people allergic to native Australian ants might be simplified by the dominance of a limited number of ant species and IgE binding cross-reactivity between venoms, as was evident in this study.

Adult↗
PubMed1999

Hymenoptera venom allergy: time course of specific IgE concentrations during the first weeks after a sting.

Detection of IgE antibodies specific to honeybee or Vespula venoms is an important criterium firstly for the diagnosis of sensitization and secondly for the indication for a specific immunotherapy. Some authors recommend to postpone blood analysis after an insect sting for a certain time because circulating IgE antibodies might be consumed by the allergic reaction, which would result in a false-negative test outcome. We investigated IgE concentrations during the first weeks after an insect sting in 31 patients with an unequivocal history of an anaphylactic reaction after a honeybee (n = 13) or Vespula (n = 18) sting. Blood samples for analysis of specific IgE concentrations (CAP system, Pharmacia Diagnostics, Sweden) were collected within 2 weeks and 5+/-2 weeks after the insect sting. 12/13 patients with honeybee venom and 14/18 patients with Vespula venom sensitization had CAP classes 1 or higher within the first 2 weeks. Those 5 patients with CAP class 0 within the first 2 weeks had detectable IgE concentrations a few weeks later. We conclude that testing for specific IgE to hymenoptera venoms is in most cases useful even during the first 2 weeks after the hymenoptera sting. This allows early decisions on further diagnostic procedures and the therapeutic way to choose. Patients with no detectable IgE should, however, be retested after a few weeks.

Adolescent↗
PubMed1993

Clinical and histologic characterization of cutaneous reactions to stings of the imported fire ant (Solenopsis invicta) in dogs.

Four adult dogs received experimentally controlled stings in the dorsolateral abdominal skin by imported fire ants (Solenopsis invicta). The sites were examined grossly 15 minutes and at 1, 2, 3, 4, 5, 6, 24, 48, and 72 hours and histologically 15 minutes and 6, 24, 48, and 72 hours after stinging. The initial gross lesions at 15 minutes were swelling and erythema, and the microscopic changes were vascular congestion and superficial dermal edema. By 6 hours, the lesions consisted of bright erythematous pruritic papules characterized microscopically by a band of full thickness dermal necrosis and inflammation. By 24 hours and continuing to the end of the study at 72 hours, the sites appeared completely normal grossly. Biopsies taken 24, 48, and 72 hours after stings contained microscopic changes similar to those present at 6 hours after stings. These histologic changes are unlike those described for human beings stung by imported fire ants. In human beings, fire ant stings are characterized histologically by an initial superficial vesicle that evolves into a sterile pustule.

Animals↗
PubMed2001

Use of stun guns for venomous bites and stings: a review.

During the past 2 decades, articles suggesting that stun guns be utilized to treat venomous bites and stings have appeared in both the lay and medical press. Although never widely considered to be standard therapy for venomous bites and stings, stun guns are still considered to be a treatment option by some medical practitioners and outdoor enthusiasts. A Medline search was performed using these terms: venomous bites, venomous stings, snake bites, spider bites, electrical, stun gun, high voltage electricity, low amperage electricity, direct current, and shock therapy. Articles selected included laboratory-based isolated venom studies, animal studies, and case reports involving humans in which a stun gun or some other source of high voltage, low amperage direct current electric shocks were used to treat actual or simulated venomous bites or stings. We concluded that the use of stun guns or other sources of high voltage, low amperage direct current electric shocks to treat venomous bites and stings is not supported by the literature.

Bites and Stings↗
PubMedDate not supplied

Decreased incidence of stings in venom-sensitive patients following venom immunotherapy.

We re-questioned 23 patients from our Venom Referral Clinic after three or more years of venom immunotherapy to determine whether venom immunotherapy makes venom-sensitive patients less susceptible to future stings. They were asked the same questions regarding stings, including: The number of stings in the previous 2 years, insects involved, time spent out of doors per week, and avoidance techniques. The number of patients stung in the previous 2 years dropped from 87% to 30%. Furthermore, the mean number of stings in 2 years per subject was 1.30 compared to 2.26 prior to these patients receiving venom immunotherapy. The average number of hours spent out of doors for this group of patients increased from 16.7 hrs per week to 18.9 hrs per week. Therefore, these patients were stung less frequently despite spending somewhat more time out of doors. We conclude that the process of desensitization during venom immunotherapy makes venom-sensitive patients less susceptible to future stings.

Animals↗
PubMed1993

First aid treatment of jellyfish stings in Australia. Response to a newly differentiated species.

Vinegar has been shown to inhibit neomatocyst discharge in Chironex fleckeri, the deadly north Australian box-jellyfish, and application of vinegar has become accepted first aid, not only for box-jellyfish stings, but also for stings by other Australian jellyfish. However, in a newly differentiated species of Physalia in Australian waters, which causes severe envenomation, vinegar was found to cause discharge in up to 30% of neomatocysts. In treating these stings, the use of vinegar is not recommended as it may increase envenomation. Stings from the single-tentacled Physalia utriculus (the "bluebottle") are not severe, tentacles with unfired nematocysts rarely adhere to the victim's skin and vinegar dousing is not required. Vinegar treatment is therefore an unnecessary step in the first aid management of any Physalia sting but remains an essential first aid treatment for all cubozoan (box) jellyfish tested to date.

Acetates↗
PubMed2006

A randomised controlled trial of hot water (45 degrees C) immersion versus ice packs for pain relief in bluebottle stings.

OBJECTIVE: To investigate the effectiveness of hot water immersion for the treatment of Physalia sp. (bluebottle or Portuguese Man-of-War) stings. DESIGN: Open-label, randomised comparison trial. Primary analysis was by intention to treat, with secondary analysis of nematocyst-confirmed stings. One halfway interim analysis was planned. SETTING: Surf lifesaving first aid facilities at two beaches in eastern Australia from 30 December 2003 to 5 March 2005. PARTICIPANTS: 96 subjects presenting after swimming in the ocean for treatment of an apparent sting by a bluebottle. INTERVENTIONS: Hot water immersion (45 degrees C) of the affected part versus ice pack application. MAIN OUTCOME MEASURES: The primary outcome was a clinically important reduction in pain as measured by the visual analogue scale (VAS). Secondary outcomes were the development of regional or radiating pain, frequency of systemic symptoms, and proportion with pruritus or rash on follow-up. RESULTS: 49 patients received hot water immersion and 47 received ice packs. The two groups had similar baseline features, except patients treated with hot water had more severe initial pain (VAS [mean +/- SD]: 54 +/- 22 mm versus 42 +/- 22 mm). After 10 minutes, 53% of the hot water group reported less pain versus 32% treated with ice (21%; 95% CI, 1%-39%; P = 0.039). After 20 minutes, 87% of the hot water group reported less pain versus 33% treated with ice (54%; 95% CI, 35%-69%; P = 0.002). The trial was stopped after the halfway interim analysis because hot water immersion was shown to be effective (P = 0.002). Hot water was more effective at 20 minutes in nematocyst-confirmed stings (95% versus 29%; P = 0.002). Radiating pain occurred less with hot water (10% versus 30%; P = 0.039). Systemic effects were uncommon in both groups. CONCLUSIONS: Immersion in water at 45 degrees C for 20 minutes is an effective and practical treatment for pain from bluebottle stings.

Adolescent↗