Electrical treatment of venomous bites and stings.
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In addition to the Hymenoptera, less common arthropods, such as spiders and reduviids, can inflict injuries of medical importance. Identification of the source of the bite or sting may be difficult but is essential to proper treatment. Part 1 of this article describes recognition and treatment of the bites of various spiders; part 2, beginning on page 107, considers bites and stings of other arthropods.
Arthropods capable of penetrating human skin often cause severe local and systemic reactions. Local reactions suggest delayed hypersensitivity while systemic symptoms resemble more the anaphylactic shock in animals. The nature of the antigen remains obscure but predominant evidence suggests its presence throughout the entire organism. Positive history of hypersensitivity to insect injectants was obtained in approximately 20 per cent of persons in the course of routine interviews of 1,078 patients. Repeated bites and stings at long or irregular intervals often induce a state of hypersensitivity, while repeated regular injections of extracts of these insects at shorter intervals may greatly reduce the hypersensitivity. The clinical evidence of allergic sensitivity to insect bites and stings cannot be readily confirmed by skin testing or by other immunological procedures. The history and the character of the lesions as well as certain entomological knowledge of the habits of the insects offer a better basis for specific diagnosis. Treatment with extracts of the whole offending insect generally provides good results but the protection afforded by such treatment varies in degree and duration.
Over an eight and a half year period 742 patients were assessed for allergy to stinging and biting insects in Queensland; 452 (61%) had allergic reactions to honey bees, 244 (33%) to wasps, 30 (4%) to various ants, 11 (1.5%) to march flies (Tabanus sp.) and five to tick infestation. One hundred and fifty one patients (20%) presented with large local swelling only (RXN1), 98 (13%) with urticaria and/or facial angioedema distant from the sting site (RXN2) and 492 (66%) with subjective or objective evidence of dyspnoea or hypotension (RXN3). Allergy testing was performed with honey bee and wasp venoms by skin testing or by Radioallergosorbent testing. Fifty nine patients (30%) with RXN3 responses to wasps failed to react to either test, while this applied to only 19 (6%) of the patients with RXN3 responses to bee stings. Thus, a large number of wasp-allergic patients with RXN3 responses could not be offered immunotherapy. A similar problem exists in the lack of availability of specific reagents for anti- and tick-induced dyspnoea or hypotension. A whole-body insect extract of march fly, however, appears useful.
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