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Bites, stings and infestations can be fatal. Anaphylaxis to vespids and bees can be prevented with immunotherapy. Patients should be referred to an allergist. The acute care and prevention of arthropod injury is discussed below.
Readily available information as to the management of arthropod bites, stings, and infestations is important to have but often difficult to find. This article brings such information together in one reference for use by the practicing pediatrician, dermatologist, and family practitioner. Preventive measures are stressed and therapy is outlined for each entity; the rationale for many of the interventions is discussed. It is not the intent of this paper to cover each subject comprehensively.
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Most of us live in cities and nature seems beneficial. Unfortunately, invertebrates and vertebrates may be aggressive. We will try here a review of the diseases caused by arthropods and other noxious animals. Injuries caused by the following insects will be described: mosquitoes, flies, fleas, bees, wasps and ants, bugs, beetles, butterflies and caterpillars. In the class arachnida: spiders, scopions, ticks and mites. Among invertebrates: leeches, anemons, corals, sea urchins, sponges and mollusca. Noxious or venomous vertebrates will not be forgotten. Basic and practical attitudes are proposed.
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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.
Most of the encounters with biting and stinging insects result in more or less pronounced localized reactions. Typically, urticarial wheals and papular reactions are observed. Less often local bullous or hemorrhagic or disseminated papular reactions, particularly in children and immunologically naive adults, may be seen. With the exception of bee and wasp venom allergies, immediate-type allergic reactions to arthropod stings and bites are rare. Systemic IgE-mediated hypersensitivity has also been reported from additional hymenoptera species, e.g. hornets, bumble bees and ants. Rare are systemic reactions to mosquitoes, flies or kissing bugs and exceptional from ticks, bed bugs, moths, caterpillars and spiders. A major problem is the often lacking standardization of extracts for skin testing and for the determination of specific IgE. Some of the allergens have been characterized and few of them synthesized using recombinant techniques. Most investigations have been made with whole-body extracts or extracts from salivary glands, while desensitization has rarely been attempted. Currently, primary prevention by avoidance of stings and bites, and adequate instruction of sensitized individuals in the use of emergency drugs are mandatory.
Although serious envenomation injuries are rare in the United States, all emergency workers should be prepared for them. Most severe complications occur in people with previous allergies or pre-existing conditions. Many people, especially those with prediagnosed allergies, will be capable of self-treatment prior to EMS's arrival; however, prepare for the worst. EMS personnel should know how to treat virtually any envenomation injuries with general practices, and should inform the receiving hospital so venom-specific treatment can be prepared. Crews should also know what creatures are indigenous to their areas and know what to expect when the tones go off. Be aware that a side effect of any animal bite or sting, whether venomous or not, is bacterial infection. Remind patients of this. The hospital physician will also educate them about infection. If you respond to a call but the patient refuses transport and signs a waiver, you must educate him about possible bacterial contamination from the bite or sting. Never waive a patient until he has been educated regarding his injury and still refuses transport.
Two cases of poisoning produced by the unusual attack of colonies of insects from the family Bombidae, commonly known as bumblebees, are described. This type of poisoning may become severe toxicity and it is analyzed in the light of the latest findings. It is characterized by hemorrhagical symptoms, such as hematemesis and melaena.
BACKGROUND: Stings and bites from various insects are responsible for many anaphylactic events. OBJECTIVE: To document the clinical features of specific forms of anaphylaxis and investigate clinical concerns regarding stinging and biting insect allergy. METHODS: All patients presenting for evaluation of adverse reactions to insect stings or bites between December 1980 and December 1997 had the clinical details of their reactions recorded and their reactions classified. RESULTS: The spectrum of clinical symptoms and signs is similar to that seen in anaphylaxis from other sources; stings on the head or neck are not more likely to cause life-threatening reactions than stings elsewhere on the body; a lesser reaction will not necessarily lead to a more serious reaction from a future sting; asthmatic patients do appear to have an increased risk of asthma as a feature of their anaphylactic response; anaphylaxis is usually confined to a particular insect species for the individual patient; patients who have had multiple stings at one time may have experienced true anaphylaxis and not a "toxic" response; and patients who have had anaphylaxis from other sources are at no greater risk than that of the general population of reacting similarly to insect stings or bites. CONCLUSIONS: Anaphylactic events from insect stings show the same clinical features as those from other sources. Systemic reactions seem confined to a specific insect species. Patients who experience RXN3 reactions from multiple stings at one time should undergo specific venom testing, because many have experienced true anaphylaxis and not a toxic response. Future consideration should be given to the role of beta-adrenergic antagonists and ACE inhibitors in patients with systemic reactions.
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