Wasp sting pdf

Bedbug infestation, in particular, has become more common e37 , e38 ; not merely humble lodgings, but even high-class ones are now affected. Reactions to bedbug bites are often misinterpreted, e. Bite reactions are treated symptomatically like reactions to Hymenoptera stings Box 1. Parasites should be eliminated with appropriate professional help.

We will only briefly mention reactions provoked not by bites, but by other types of contact with insects. In Germany, reactions to the poisonous hairs setae of the oak processionary caterpillar Thaumetopoea processionea have been observed e These bear thaumetopoein, a protein toxin that can also induce IgE-mediated sensitization.

Setae can persist in the environment for a long time Mosquitoes, horseflies, and other Diptera often induce local sting reactions, but only rarely systemic ones. Bedbugs are becoming more common. Pathogenic airborne allergens derived from many different kinds of insects can cause disease, particularly of the respiratory tract In central Europe, cockroaches are the main insect source of allergens in the general environment, although allergy can obviously develop to any insect species given sufficient occupational or leisure-time exposure.

Reactions to the oak processionary caterpillar are now being seen more commonly in Germany. They are induced by a toxic protein thaumetopoein found on the hairs of the caterpillar.

The basal serum tryptase concentration was 7. Skin inspection revealed no evidence of cutaneous mastocytosis. In view of the history and test findings, a diagnosis of grade III anaphylaxis due to bee-venom allergy was made.

To make the specific immunotherapy tolerable, treatment with omalizumab was initiated. Omalizumab was then given once every 4 to 6 weeks for a total of 6 injections. Even after omalizumab was stopped, the specific immunotherapy was well tolerated without any systemic side effects. Two months after taking her last dose of omalizumab, the patient was able to tolerate a sting challenge test with a live bee without any systemic reaction. Because of her occupational exposure, the patient in this case needed to be protected quickly and reliably against further anaphylactic sting reactions.

Therefore, the sting challenge test was performed two months after the maintenance dose had been reached earlier than usual and revealed that the treatment had not yet succeeded. The repeated systemic reactions to specific immunotherapy that arose thereafter were suppressible by pre- and comedication with omalizumab. The repeated sting provocation test was well tolerated without any systemic reaction.

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Only one answer is possible per question. Please select the answer that is most appropriate. A sting from what type of insect most commonly provokes a local allergic reaction? How common is anaphylaxis in response to a bee or wasp sting in the general population? The treatment of anaphylaxis depends on its severity. What drug is given first in anaphylactic reactions involving more than just the skin?

Allergologic testing is required in patients who have had an episode of bee or wasp venom anaphylaxis. If the history suggests sensitization, but this cannot be demonstrated either by a skin test or by the measurement of specific IgE antibodies in the serum, what test should be performed next? A year-old girl is stung in the left big toe, presumably by a bee, while playing in a meadow. The foot and the lower portion of the leg become markedly red and swollen. What allergological tests are indicated?

A skin-prick test with bee and wasp venom and measurement of specific IgE antibodies against bee and wasp venom in the serum. A skin-prick test with bee venom and measurement of specific IgE antibodies against bee venom in the serum.

A year-old woman who sells baked goods is stung by a wasp in the bakery and develops anaphylaxis with cardiopulmonary arrest. She is successfully resuscitated and makes a full recovery after a brief stay in the hospital.

Skin testing and the measurement of specific IgE antibodies in the serum reveal sensitization to wasp venom, but not to bee venom. Her basal serum tryptase level was elevated She therefore underwent a bone biopsy leading to the diagnosis of an indolent systemic mastocytosis.

Specific immunotherapy with wasp venom was initiated. How long should it be continued? Until the success of treatment is documented with a well-tolerated sting challenge test. Beta-blockers are generally contraindicated in patients who have had an episode of anaphylaxis and should only be given when they are absolutely necessary and cannot be replaced by other drugs. Of what other class of drug can the same be said? He has never been stung by a bee in his life, there is no evidence of mastocytosis, and his basal serum tryptase level is not elevated.

What should be done next? What treatment is indicated? Conflict of interest statement. He has also received payment for carrying out clinical studies on behalf of HAL and Novartis. National Center for Biotechnology Information , U.

Journal List Dtsch Arztebl Int v. Dtsch Arztebl Int. Published online Mar Bernhard Przybilla , Univ. Author information Article notes Copyright and License information Disclaimer. Received Dec 6; Accepted Feb Copyright notice. See the reply " Correspondence reply : In Reply " in volume on page This article has been cited by other articles in PMC. Abstract Background In human beings, local and systemic reactions can be caused both by blood-sucking insects and by venomous insect stings.

Methods This article is based on a selective literature review, including guidelines from Germany and abroad. Results Insect venom induces a toxic reaction at the site of the sting. Conclusion Insect stings can cause severe disease. Learning objectives This article is intended to provide readers with an overview of the clinical features, diagnosis, and treatment of reactions to insect stings, and basic knowledge of the treatment of patients with immediate systemic reactions to bee or wasp stings.

Introduction The most common type of reaction to an insect sting is a local reaction to the bite of a mosquito a small fly of the family Culicidae. Reactions to insect stings. Hymenoptera stings The venomous stinger of Hymenoptera evolved from their egg-depositing apparatus. The allergens most commonly causing IgE-mediated anaphylaxis are: in bee venom, phospholipase A2, hyaluronidase, and probably acid phosphatase and a serine protease, in wasp venom, phospholipase A1, hyaluronidase, and antigen 5.

Hymenoptera venoms. Local reactions to bee and wasp stings The toxic effect of a sting in the skin manifests itself as an area of pain, redness and swelling that is generally less than 10 cm in diameter and improves markedly within 24 hours.

Local reactions to bee and wasp stings. Box 1 The treatment of acute reactions to bee and wasp stings from [ 2 ]. Box 2 The long-term treatment of bee- or wasp-venom allergy from [ 2 ]. Systemic reactions to bee and wasp stings In multiple stings, the toxin can cause severe or even fatal illness. Anaphylaxis induced by bee and wasp stings Anaphylaxis induced by a bee or wasp sting is a common problem that affects 1. Open in a separate window. Systemic reactions to bee and wasp stings.

Anaphylaxis due to bee and wasp stings. Table 2 Emergency drugs for self-administration by children 2 , 4 : special aspects.

The most important steps in the treatment of anaphylaxis after a bee or wasp sting. The diagnostic evaluation of anaphylaxis due to a bee or wasp sting In taking the history, the physician should inquire about the nature of the insect sting reaction s and the circumstances in which it arose.

Special aspects of emergency medication and self-treatment for children. Additional studies Should these tests be negative as well, cellular testing can provide additional help, particularly a basophil activation test with flow-cytometric determination of the expression of the activation markers CD63 or CDc e10 , e Box 3 Risk factors for anaphylaxis due to Hymenoptera venom 2.

Additional tests. Specific immunotherapy with bee or wasp venom Specific immunotherapy SIT is the treatment of first choice for patients who have had a systemic immediate reaction to a Hymenoptera sting.

SIT is indicated for adults in sting anaphylaxis of grade II or higher, or grade I with a risk factor box 3 or impaired quality of life due to insect-venom allergy, and demonstrated sensitization to the reaction-inducing venom Specific immunotherapy SIT with bee or wasp venom.

Pregnancy and SIT. The treatment of acute reactions to bee and wasp stings. Long-term treatment after anaphylaxis due to bee or wasp venom. Diptera bites Blood-sucking Diptera, most importantly mosquitoes Culicidae but also others including horseflies Tabanidae , are the most common inducers of local, allergic bite reactions, usually seen as wheals, papules, or a biphasic response wheals and papules.

The duration of specific immunotherapy. Lice, bedbugs, fleas Pediculus humanus capitis the head louse , P. Other reactions due to contact with insects We will only briefly mention reactions provoked not by bites, but by other types of contact with insects. Blood-sucking insects. Other reactions to insects. Within minutes, she developed generalized pruritus, urticaria, dyspnea, and dizziness, and then lost consciousness for about 5 minutes.

She received emergency medical treatment at once and was hospitalized; one day later, she had fully recovered.

She was generally in good health and had not been taking any medications at the time of the sting. Solutions: 1e, 2d, 3d, 4d, 5d, 6a, 7b, 8b, 9c, 10a. Question 1 A sting from what type of insect most commonly provokes a local allergic reaction?

Thrombocytopenic purpura Serum sickness Anaphylaxis Systemic intoxication Airway obstruction by local reaction Question 3 How common is anaphylaxis in response to a bee or wasp sting in the general population? A basophil activation test Measurement of specific IgG antibodies in the serum A lymphocyte stimulation test A sting challenge test An inhibition test to detect cross-reacting IgE antibodies Question 6 A year-old girl is stung in the left big toe, presumably by a bee, while playing in a meadow.

A skin-prick test with bee and wasp venom and measurement of specific IgE antibodies against bee and wasp venom in the serum A skin-prick test with bee venom and measurement of specific IgE antibodies against bee venom in the serum A basophil activation test with bee and wasp venom None Measurement of specific IgG antibodies against bee and wasp venom in the serum Question 7 A year-old woman who sells baked goods is stung by a wasp in the bakery and develops anaphylaxis with cardiopulmonary arrest.

Until the success of treatment is documented with a well-tolerated sting challenge test For 3 years For 5 years For life For as long as she remains at risk for a wasp sting in the workplace Question 8 Beta-blockers are generally contraindicated in patients who have had an episode of anaphylaxis and should only be given when they are absolutely necessary and cannot be replaced by other drugs. Topical glucocorticoid and oral H 1 -blocker Topical H 1 -blocker Oral glucocorticoid Topical H 1 -blocker, oral non-steroidal anti-inflammatory agent Topical H 1 -blocker, intramuscular glucocorticoid.

References 1. Hemmer W. Allergo J. Diagnose und Therapie der Bienen- und Wespengiftallergie. Predictors of severe systemic anaphylactic reactions in patients with Hymenoptera venom allergy: importance of baseline serum tryptase - a study of the European Academy of Allergology and Clinical Immunology Interest Group on Insect Venom Hypersensitivity.

J Allergy Clin Immunol. Anaphylaxie bei Kindern und Jugendlichen. Epidemiologie der Insektengiftallergie. Pumphrey RS. Fatal posture in anaphylactic shock. Akuttherapie anaphylaktischer Reaktionen. In allergic persons, venom components circulating in the body combine with antibodies that are associated with mast cells resting on vital organs.

The mast cells release histamine and other biologically active substances. This results in a leakage of fluid out of the blood and into the body tissues. Blood pressure drops dangerously low, and fluid builds up in the lungs. Anaphylaxis, if treated in time, usually can be reversed by the effects of epinephrine adrenaline injected into the body. Individuals who are aware that they are allergic to stings should carry an epinephrine injection device whenever they think they may encounter stinging insects.

Epinephrine is obtainable only by prescription from a physician. Another method of combating anaphylaxis is desensitization. In this approach, the patient is subjected to injections of the venom to which he or she is allergic in increasing doses over a period of time.

Like hay fever shots, the tactic is to build up a protective concentration of antibodies in the blood that will intercept and tie up the venom components before they can reach the antibodies on the mast cells.

Occasionally a person becomes involved in a situation where he or she is stung many times before being able to flee from the nesting site. Depending on the number of stings, the person may just hurt a lot, feel a little sick, or feel very sick. Humans can be killed if stung enough times in a single incident. With honey bees the toxic dose LD50 of the venom is estimated to be 8. Obviously, children are at a greater risk than adults. In fact, an otherwise healthy adult would have to be stung more than 1, times to be in risk of death.

Most deaths caused by multiple stings have occurred in men in their 70s or 80s who were known to have poor cardiopulmonary functioning. A second, potentially life-threatening result of multiple stings occurs days after the incident.

Proteins in the venom act as enzymes; one dissolves the cement that holds body cells together, while another perforates the walls of cells. This damage liberates tiny tissue debris that normally would be eliminated through the kidneys. If too much debris accumulates too quickly, the kidneys become clogged and the patient is in danger of dying from kidney failure. It is important for persons who have received many stings at one time to discuss this secondary effect with their doctors.

Wasp stings are as potent in this respect as bee stings. Patients should be monitored for a week or two following an incident involving multiple stings to be certain that no secondary health problems arise. Bees and wasps can be attracted to, or may react to, odors in the environment. Unless someone accidentally collides quite hard with or swats at a bee or wasp, it is not likely to sting. Avoid going barefoot in vegetation, especially clover and blooming ground covers.

Also avoid wearing brightly colored or patterned clothing. If you remain calm when a bee or wasp lands on your skin to inspect a smell or to get water if you are sweating heavily, the insect eventually will leave of its own accord. When swimming in pools, watch out for bees or wasps trapped on the surface of the water. Stinging incidents often occur when nesting areas of social insects are disturbed. Wasp venom is a complex mixture of toxic substances such as Phospholipase A, Phospholipase B, Apamine, Hyalouronidase, Mast cell degranulating peptide and Mastoparan peptide, which is implicated in direct mast cell degranulation leading to histamine release.

A wide range of immunologically mediated ocular sequel have been described which include focal or diffuse corneal edema, bullous keratopathy, panuveitis, hyphema, anterior polar cataract, papillodema, lens subluxation and optic neuritis.

The author hereby tends to report a case of Striate Keratitis following wasp sting, its expected pathogenesis, treatment and outcome. Minimal lid edema was present. Generalized Corneal wasp sting; Hymenoptera; Striate keratitis conjunctiva hyperemia was present. Pupillary reactions were normal. No history of hypertension, injury to her right cornea while gardening. She presented within two DM or use of traditional eye medicines could be elicited Figure 2. The patient complained of severe eye pain along with redness, tearing and mild blurring of vision Figure 1.

J Clin Exp Ophthalmol 7: The lid swelling was expected to be a consequence of ocular trauma [1]. Bee and wasp stings can directly initiate a variety of ocular Keeping this in mind the patient was started on antibiotic steroid manifestations, as well as yield secondary systemic repercussions.

Patient was told to report in case redness, blurred vision or females of Hymenoptera species usually lies in the abdomen and pain worsened. After 5 days of treatment the corneal edema decreased has toothed lancets and venomous glands. Therefore, only female dramatically and lid swelling resolved. The antibiotic steroid insects are capable of producing sting injuries [3]. Honeybee during the act of stinging introduces its chitinous barbed sting and specific venom into the cornea.

While wasps, hornets and bumblebees do not own a hooked stinger, parts of this assembly sometimes get fragmented and persist in tissue. Hence sting wounds to ocular structures frequently terminate in a penetrating injury and a foreign body impact. During the process of stinging, an eminently poisonous, species-precise toxin is introduced and actively forced into host tissue.