Bite Reactions Research Articles

Epidemiology of Mosquito Bite Allergy in the Centre of Allergy and Clinical Immunology of Monterrey, Mexico

RATIONALE: To know the prevalence and type of allergic reactions to mosquito bite in our population, we performed a descriptive cross sectional study.METHODS: 482 patients ranged in age from 2 to 58 years referred to our centre were evaluated. A questionnaire on mosquito bite reactions history was applied to the adult patients and the parents' children. Additionally, skin prick test (SPT) were performed in all of these subjects with common aeroallergens of the northeastern of Mexico and whole body extract of Aedes aeigypti (a common mosquito species in Mexico).RESULTS: The mean age of the subjects was 18.5 ± 14.8 years. 257 (53.3%) were female. 307 (63.7%) were atopic with positive SPT to at least one aeroallergen. 395 (82%) had a positive history of local reactions to mosquito bites, but only 12 (2.5%) presented large local reactions (8 were younger than 10 years). The most common local reactions included erythema, itching, papules and small wheals. Only one patient (0.2%) had history of systemic reaction characterized by urticaria. SPT to mosquito was positive in 85 subjects (17.6%) and 78 of them had history of local reactions (p = 0.24), but only 3 of them were large. There were not differences in the sensitization to mosquito between atopic and no atopic subject (p> .05).CONCLUSIONS: Local reactions to mosquito bites are common and sensitization to this insect is frequent in our population. In general, the prevalence of large local reactions is relatively low, although it is greater in children. Allergic systemic reactions seem to be rare. RATIONALE: To know the prevalence and type of allergic reactions to mosquito bite in our population, we performed a descriptive cross sectional study. METHODS: 482 patients ranged in age from 2 to 58 years referred to our centre were evaluated. A questionnaire on mosquito bite reactions history was applied to the adult patients and the parents' children. Additionally, skin prick test (SPT) were performed in all of these subjects with common aeroallergens of the northeastern of Mexico and whole body extract of Aedes aeigypti (a common mosquito species in Mexico). RESULTS: The mean age of the subjects was 18.5 ± 14.8 years. 257 (53.3%) were female. 307 (63.7%) were atopic with positive SPT to at least one aeroallergen. 395 (82%) had a positive history of local reactions to mosquito bites, but only 12 (2.5%) presented large local reactions (8 were younger than 10 years). The most common local reactions included erythema, itching, papules and small wheals. Only one patient (0.2%) had history of systemic reaction characterized by urticaria. SPT to mosquito was positive in 85 subjects (17.6%) and 78 of them had history of local reactions (p = 0.24), but only 3 of them were large. There were not differences in the sensitization to mosquito between atopic and no atopic subject (p> .05). CONCLUSIONS: Local reactions to mosquito bites are common and sensitization to this insect is frequent in our population. In general, the prevalence of large local reactions is relatively low, although it is greater in children. Allergic systemic reactions seem to be rare.

Levocetirizine for Treatment of Immediate and Delayed Mosquito Bite Reactions

People frequently experience whealing and delayed papules from mosquito bites. Various antihistamines have previously been tried for the treatment of this condition. We performed a double-blind, placebo-controlled, cross-over study with levocetirizine 5 mg and matched placebo in 30 adults who were sensitive to mosquito bites. On the third treatment day the subjects received two Aedes aegypti bites on the forearm. The size of the bite lesions and the intensity of pruritus (visual analogue scale) were measured. Bite symptoms could be analysed in 28 subjects at 15 min and in 8 subjects at 24 h. Levocetirizine decreased the size of wheals by 60% (p < 0.001) and accompanying pruritus by 62% (p < 0.001) compared with placebo. The effect of levocetirizine increased in a linear fashion with the size of wheals and was most significant in the subjects with largest bite lesions. Levocetirizine also decreased the size of 24-h bite lesions by 71% (p=0.008) and accompanying pruritus by 56% (p=0.016). These results show that prophylactic levocetirizine 5 mg is an effective treatment for both immediate and delayed mosquito bite symptoms and is especially effective in subjects with large wheals.

Bullous Allergic Hypersensitivity to Bed Bug Bites Mediated by IgE against Salivary Nitrophorin

In Central Europe, bites from the common bed bug (Cimex lectularius) are nowadays rather uncommon. Nevertheless, infestations are sometimes observed in old framehouses and by immigration due to international travel and migration. The clinical picture of bug bites substantially varies between individuals, depending upon previous exposure and the degree of an immune response. The host immune response and potential protein antigens present in the saliva of C. lectularius or specific antibodies have not been characterized thus far. We describe a patient with bullous bite reactions after sequential contact with C. lectularius over a period of 1 year. In skin tests, we observed immediate reactions to the salivary gland solution of C. lectularius, which were followed by a pronounced partially blistering late-phase response. Immunoblot analysis of the patient's serum with salivary gland extracts and recombinant C. lectularius saliva proteins revealed specific IgE antibodies against the 32 kDa C. lectularius nitrophorin, but not to 37 kDa C. lectularius apyrase. Our data demonstrate that bullous cimicosis may be the late-phase response of an allergic IgE-mediated hypersensitivity to C. lectularius nitrophorin.

Prominent Papillary Dermal Edema in Dermatophytosis

The histological findings in tinea corporis are variable, but include parakeratosis, often with neutrophils, spongiosis, and dermal inflammation. A recent study found some degree of papillary dermal edema in 17 to 23% of tinea cases. We report five cases of tinea corporis in which prominent papillary dermal edema (PDE) was the salient histological finding. Prominent PDE is often associated with diagnoses such as Sweet syndrome, polymorphous light eruption, allergic contact dermatitis and arthropod bite reactions. Interestingly, the submitted clinical diagnoses for our cases included Sweet syndrome (2), arthropod bite reaction (2), immunobullous disease (2), fixed drug eruption (1), eczema (1) and tinea (2). Our first case was a 25‐year‐old female with recurrent edematous plaques in fixed sites. Her lesions completely cleared with repeated courses of systemic steroids, but recurred after steroid taper. One fungal hypha was overlooked on her first biopsy and she was erroneously diagnosed with fixed drug eruption or a blistering disease (immunofluorescence negative). Six months later, repeat biopsy showed PDE, and numerous hyphae were seen on PAS stain. This prompted us to carefully examine PAS‐stained sections on subsequent cases with prominent PDE. Prominent papillary dermal edema may be a clue to dermatophyte infection.

Thrombogenic Vasculopathy and Interstitial to Diffuse Dermal Neutrophilic Inflammation as a Histologic Manifestation of Tick Bite Reaction

Ticks are ectoparasites that cause dermatologic disease both directly through physical trauma to the skin, salivary secretions, or remnant body parts, and indirectly through transmission of disease. Lyme disease, Rocky Mountain spotted fever, tularemia, and babesiosis are known tick‐transmitted diseases. The histopathology related to a primary tick bite, similar to other arthropod bites, classically consists of a perivascular infiltrate composed of lymphocytes, neutrophils, histiocytes, plasma cells, and eosinophils in varying amounts. We describe five patients with a novel histologic reaction to embedded tick parts., Each case demonstrates a thrombotic vasculopathy consisting of intraluminal eosinophilic deposits that stain strongly with Periodic acid Schiff stain. The adjacent tissue shows dermal necrosis with surrounding interstitial to diffuse dermal neutrophilic inflammation. We postulate that diffuse dermal nutrophilic infiltrates in association with thrombogenic vasculopathy is an unusual histologic picture of tick bite reactions that may be attributable to remnant tick parts.

Persistent excoriated papules

A 32-year-old otherwise healthy man presented with a 2-month history of mildly pruritic erythematous papules and vesicles that evolved into central crusting. The physical examination revealed multiple erythematous papules with peripheral scales and central crusting on the trunk and proximal extremities (Fig 4).6.The differential diagnosis includes all the following except (Choose single best response.)a.lymphomatoid papulosisb.pityriasis lichenoides et varioliformis acutac.smallpox infectiond.guttate psoriasise.arthropod bite reaction

An itchy vesiculobullous eruption in a patient with chronic lymphocytic leukaemia

Exaggerated reactions to insect bites are characteristic of patients with haemoproliferative disorders, particularly chronic lymphocytic leukaemia (CLL). Skin lesions usually appear after the diagnosis of leukaemia and seem unrelated to laboratory findings, disease course or therapy. Rarely, the eruption may precede the diagnosis of the haematologic malignancy. The patients usually do not recall of insect bites, and the diagnosis may require histological and laboratory investigations to exclude specific lesions or autoimmune bullous diseases. Lesions may run a chronic course and represent a therapeutic challenge. Here, we report an adult patient with CLL who developed itchy recurrent papulovesicular and bullous lesions. Differential diagnosis was made with cutaneous specific lesions of CLL, bullous pemphigoid and pemphigus vulgaris, but laboratory and histological investigations confirmed the diagnosis of an insect bite reaction. The patient was treated with oral H1 anti-histamines and topical corticosteroids under occlusion, with marked improvement after 10 days.

Granulomatous Eccrinotropic Lymphomatoid Papulosis

We describe 9 patients with a novel variant of lymphomatoid papulosis characterized by prominent localization of the infiltrate around the eccrine coil, resulting in nodular expansion of the coil accompanied by variable granulomatous inflammation. Light microscopy, immunohistochemical analysis using antibodies to CD2, CD3, CD4, CD5, CD7, CD8, and CD30 in 6 cases, and polymerase chain reaction–singlestranded conformational polymorphism analysis for Tcell receptor γ chain gene rearrangement in 5 cases revealed 2 cytomorphologic patterns (large cell dominant with polymorphous inflammation, small cell lymphocyte-rich with an inconspicuous large cell component [phenotypes, CD30+/CD3+/CD4+/CD7– for large atypical cells; reactive for small lymphocytes]) and clonal restriction in 4 and polyclonality in 1 of the lymphocyte-dominant cases. During an average 6-year follow-up, no lymphomas developed. Recognition of this variant is important— accentuation of the infiltrate around the eccrine coil and cutaneous nerves, presence of granulomatous inflammation, dominance of small lymphocytes in the dermis, and variable extension into the panniculus may lead to diagnostic confusion with entities such as discoid lupus erythematosus, Jessner lymphocytic infiltrate of skin, subcutaneous T-cell lymphoma, and persistent arthropod bite reaction. Our findings suggest that pruritus, a younger age at diagnosis, and a more indolent course are defining clinical features. The prototypic lymphoproliferative disorders that express the activation marker Ki-1 (CD30) are Hodgkin disease (HD), 1 anaplastic large cell lymphoma (ALCL), 2-4 lymphomatoid papulosis (LyP), 5,6 and rare cases of large cell B- or T-cell lymphoma. The distinctive manifestation of LyP is a chronic, self-limited dermatosis comprising recurrent “crops” of ulcerative nodules and papules resolving within 3 to 6 weeks, the histologic features of which comprise an atypical lymphocytic infiltrate mimicking malignant lymphoma. Roughly 10% of LyP cases manifest the subsequent or concurrent emergence of cutaneous T-cell lymphoma, HD, or ALCL. 7-9 In some cases, molecular studies suggest an evolution of lesions of LyP into mycosis fungoides (MF) or primary cutaneous CD30+ ALCL rather than the secondary lymphoma being a genomically independent event.

Itch: scratching more than the surface.

In origin, itch can be cutaneous ("pruritoceptive", e.g. dermatitis), neuropathic (e.g. multiple sclerosis), neurogenic (e.g. cholestasis), mixed (e.g. uraemia) or psychogenic. Although itch of cutaneous origin shares a common neural pathway with pain, the afferent C-fibres subserving this type of itch are a functionally distinct subset: they respond to histamine, acetylcholine and other pruritogens, but are insensitive to mechanical stimuli. Histamine is the main mediator for itch in insect bite reactions and in most forms of urticaria, and in these circumstances the itch responds well to H(1)-antihistamines. However, in most dermatoses and in systemic disease, low-sedative H(1)-antihistamines are ineffective. Opioid antagonists relieve itch caused by spinal opioids, cholestasis and, possibly, uraemia. Ondansetron relieves itch caused by spinal opioids (but not cholestasis and uraemia). Other drug treatments for itch include rifampicin, colestyramine and 17-alpha alkyl androgens (cholestasis), thalidomide (uraemia), cimetidine and corticosteroids (Hodgkin's lymphoma), paroxetine (paraneoplastic itch), aspirin and paroxetine (polycythaemia vera) and indometacin (some HIV+ patients). If the remedies specified fail, paroxetine and mirtazapine should be considered. Ultraviolet B therapy, particularly narrow-band UVB, may be superior to drug treatment for itch in uraemia.

Skin problems from marine arthropods

While the majority of the phylum Arthropoda are terrestrial, some of the aquatic members can be harmful to human skin. While none of the aquatic arthropods are known to be venomous, traumatic injuries from claws or spines can cause penetrating and laceration injuries which may lead to secondary infection. Bite reactions, poisoning from ingestion, and contact reactions are also seen due to marine arthropods. Preventive measures and treatment are discussed.

Controlled simultaneous exposition to single mosquitoes – an alternative experimental design to study mosquito bite reactions

Until now a standardized method to evoke reproducible, qualitatively comparable, statistically analysable and precisely timed and located mosquito bites for experimental purposes was lacking. We here propose a simple procedure that meets all these requirements. In two studies, single Aedes aegypti and Anopheles stephensi mosquitoes of the same age that had been raised under defined conditions were placed in gauze‐covered test tubes in direct contact to the human skin on predetermined sites. In most instances, the mosquitoes approached the skin in less than one minute, started probing through the gauze and took blood for a few minutes until they were fully engorged. In all cases, we succeeded in performing simultaneous bites of single mosquitoes, two of the same species on the same volunteer. Skin reactions resulting from the mosquito bites were tested within a clinical trial by comparing verum‐treated and placebo‐treated biting sites. In both studies, a reactive efflorescence appeared after each bite. The applied method for single‐bite exposition allows for timing of the bites and predetermination of the biting sites. It is reliable, reproducible to a high degree, and easy to perform.

Ten clues to the histopathologic diagnosis of infectious skin diseases

Specific diagnoses of infectious skin diseases can be established in dermatopathology by several methods: by algorithms based on pattern analysis, by differential diagnosis of clinicopathologically similar disorders, by attention to pitfalls, by exceptions to the rules and finally, very elegantly by clues. Ten clues to specific diagnoses of infectious skin diseases which are of importance in routine practice are presented. Clue 1: Features of an angiocentric angiodestructive lymphoma in the centre of a wedge-shaped necrotic insect bite reaction are a clue to a bite by a spider. Clue 2: Parakeratosis with spiky imprints on the surface above features of an insect bite reaction are a clue to scabies. Clue 3: A faintly eosinophilic section of a skin specimen with prominent fibrin thrombi and extravasated erythrocytes are a clue to a septic fungal vasculitis. Clue 4: Infectious agents in association with otherwise typical features of leukocytoclastic vasculitis are a clue to septic vasculitis. Clue 5: Steel-grey nuclei with marginated nucleoplasm of keratinocytes are a clue to the diagnosis of early infection by herpes virus. Clue 6: Owleye-like cells are a clue to infection by cytomegalovirus. Clue 7: Detection of Entamoeba histolytica in perianal and perineal ulcers are a clue to amebiasis. Clue 8: Round-oval to rectangular spaces within the stratum spinosum of the epidermis are a clue to larva migrans. Clue 9: Macrophages and plasma cells in association with otherwise typical features of pityriasis lichenoides are a clue to secondary syphilis. Clue 10: A lichenoid infiltrate of lymphocytes and plasma cells are a clue to acrodermatitis chronica atrophicans.

A20 加齢による蚊刺反応の変化

A20 加齢による蚊刺反応の変化

The immunohistopathological features of prurigo Hebra

Until now the pathologic mechanisms of prurigo Hebra (PH) is still understood. Earlier study the genetic inheritance of PH showed the multifactorial pattern. Considering the genetic inheritance and the existence of allergic reaction to insects bite in all patients, might be the mechanisms followed hypersensitivity reactions. The purpose of this study is to evaluate the general and specific local inflammatory features of early and late lesions of prurigo Hebra (PH). Fifty biopsy specimens of early and late lesions of prurigo Hebra patients were processed with haematoxylin-eosin (HE) and immunoperoryde (lP) staining using monoclonal antibodies against specific inflammatory cells namely B cells, T cells, helper T (CD4+) cells, supressor T (CD8+) cells, Langerhans cells, and antigen presenting cells (APC) that expressed HLA-DR antigen. HE-stained specimens: In early lesions, PMN cells were few, while eosinophils were present in great quantity and independent of mast cells and plasma cells; this feature was similar to that of insect bite reaction. IP-stained specimens: In late lesions, the amounts of lympho-histiocytic infiltration consisting of T cells, CD8+ cells, HLA-DR-expressing APCs were greater than those of early lesions, although it was not statistically significant. An exception was for the CD4+ cells, whose number in early lesions was significantly higher. The ratio of CD4+ to CD8+ in early lesions was higher than in late lesions (3/1: 2/1). This suggested that CD4+ cells were predominant. B cells, which were normally absent, appeared in small quantity in both early and late Lesions. The presence of B cells was not statistically correlated with T cells or eosinophils. The number of Langerhans cells in late lesions was higher than in early lesions. There was a strong correlation (r=0.39) between T cells and HLA-DR-expressing antigen-presenting cells (APCs/HLA-DR). Those cells found in great qunntity suggested that PH patients usually expose to extrinsic factors. In some cases with severe condition, the presence of eosinophils was more profound and was statistically significant. It is conclude that immunohistopathological mechanisms of PH follow the mixed types (one and IV) hypersensitivity reaction. (Med J Indones 2001;10:1-15) Keywords: Prurigo Hebra, eosinophils, CD4+cells, mixed (I and IV) types of hypersensitivity.

Are anaphylactic reactions to snake bites immunoglobulin E-mediated?

Bites by poisonous European snakes of the genus Vipera lead to local tissue damage and systemic symptoms such as generalized oedema, hypotension, gastrointestinal symptoms, haemolysis and renal dysfunction. Not rarely anaphylactic symptoms like urticaria, localized angioedema and asthma are observed. To look for snake venom-specific immunoglobulin (Ig) E antibodies in patients with a history of bites by European vipers and for cross-reactions with Hymenoptera venoms, that have a similar composition. Ten patients with a history of bites by Vipera aspis or Vipera berus were investigated. Three patients had been bitten only once, and two of these had developed only local reactions. Four reported previous allergic reactions to Hymenoptera stings. All patients, 10 Hymenoptera venom-allergic and five nonallergic individuals who served as controls underwent i.c. skin test endpoint titration with snake (V. aspis, V. berus) and Hymenoptera venoms (honey bee, Vespula spp.) and were investigated for specific serum IgE antibodies to the same venoms. Seven of the eight patients with systemic snake bite reactions had both positive skin tests and serum IgE antibodies to snake venoms, while these tests were negative in the two patients with only local reactions to snake bites and all controls. Seven of the eight patients with systemic snake bite reaction also had positive skin tests and specific IgE with one or both Hymenoptera venoms. By RAST-inhibition with sera of four patients with high IgE to both Vipera and Hymenoptera venoms, partial cross-reactivity could be demonstrated in one. Anaphylactic reactions following snake bites may be IgE-mediated, especially in patients with repeated bites.

181 Treatment of mosquito bite reactions with ebastine antihistamine

181 Treatment of mosquito bite reactions with ebastine antihistamine

The pigeon tick ( Argas reflexus): Severe allergic bite reactions in humans

The pigeon tick ( Argas reflexus): Severe allergic bite reactions in humans

Bullous eruption in a patient with systemic lupus erythematosus: Mite dermatitis caused by Cheyletiella blakei

Cheyletiella dermatitis probably occurs much more frequently than the paucity of reports would suggest. A British study concluded that the most frequent pet-associated dermatoses are flea bites, Sarcoptes scabiei var. canis infestation, Cheyletiella dermatitis, and forage mite dermatitis. 1 Patients seldom suspect the cause. In a study among 37 patients diagnosed with Cheyletiella dermatitis, only two suspected that their pets were the source of the dermatitis. 2 Commonly, only one member in a family experiences significant bite reactions.

Immunologic mechanisms in mosquito allergy: correlation of skin reactions with specific IgE and IgG antibodies and lymphocyte proliferation response to mosquito antigens.

Allergic reactions to mosquito bites are a common problem. Although IgE-mediated hypersensitivity has been reported, other immunologic mechanisms may be involved. To study the relationship between skin bite reactions and immunologic parameters. Forty-one subjects were experimentally exposed to mosquito (Aedes vexans) bites. Immediate and delayed skin reactions were traced at 20 minutes and 24 hours, respectively, after the bites. Sera were analyzed for mosquito salivary gland-specific IgE (mosquito-IgE) and IgG (mosquito-IgG) by ELISA. Lymphocyte proliferation assays with mosquito extract were also performed. One of 41 subjects had only a delayed skin reaction to the bite, 23 had both immediate and delayed reactions, 6 had only immediate reactions, and 11 had no reaction. The mean mosquito-IgE and -IgG concentrations were higher in the subjects with immediate reactions than in those without immediate reactions (P < .007). The mean lymphocyte proliferation stimulation index was higher in the subjects with delayed reactions than in those without delayed reactions (P < .015). Further, both mosquito-IgE and -IgG levels correlated with skin immediate and delayed reactions (P < .04), while lymphocyte proliferation indices only correlated with skin delayed reactions (P < .006). Inverse correlations were found between the size of skin reactions and the number of years lived in Canada (P < .04), but not with age. These results indicate that IgE-, lymphocyte- and, probably, local IgG immune-complex-mediated hypersensitivities are involved in mosquito allergy. Naturally acquired desensitization to mosquito bites occurs during long-term exposure.

Anaphylactic reaction after bites by Glossina morsitans(tsetse fly) in a laboratory worker

Anaphylactic reaction after bites by Glossina morsitans(tsetse fly) in a laboratory worker