Introduction We present a 67 year old male who developed anaphylaxis after being bitten by a horsefly; likely a more common diagnosis than previously documented. Case Description 67 year old male farmer presented to ED with symptoms of anaphylaxis. He had eaten crab and ten minutes later was bitten by a horsefly on his left hand. He became lightheaded, developed left arm swelling, and itchy hands. Symptoms progressed to peri-oral numbness, neck erythema, emesis and loss of consciousness. His evaluation revealed positive specific IgE by serology to HB, WA, YH, YJ, WFH, horsefly and crab. Six weeks later, patient successfully passed crab challenge. Probable horsefly-wasp syndrome suspected and patient decided to undergo VIT to mixed vespids, wasp, and honeybee. Discussion At least 30 cases of severe allergic reactions to horsefly allergy (family Tabanidae) have been recorded; however, this is thought to be underreported secondary to poor diagnostics and lack of awareness. Clinically, a co-existence of anaphylaxis to horsefly and hymenoptera has been reported. Tab y 2 (a hyaluronidase) and Tab y 5 (antigen 5) have been identified as potential allergen proteins from the saliva of the horsefly as well as wasp venom which supports evidence of horsefly-wasp syndrome. Given the patient's occupational risk, lack of specific immunotherapy for horsefly allergy, and suspected cross reactivity between the wasp and horsefly, VIT for wasp should be considered as a scientifically plausible but limited treatment option for horsefly allergy. We present a 67 year old male who developed anaphylaxis after being bitten by a horsefly; likely a more common diagnosis than previously documented. 67 year old male farmer presented to ED with symptoms of anaphylaxis. He had eaten crab and ten minutes later was bitten by a horsefly on his left hand. He became lightheaded, developed left arm swelling, and itchy hands. Symptoms progressed to peri-oral numbness, neck erythema, emesis and loss of consciousness. His evaluation revealed positive specific IgE by serology to HB, WA, YH, YJ, WFH, horsefly and crab. Six weeks later, patient successfully passed crab challenge. Probable horsefly-wasp syndrome suspected and patient decided to undergo VIT to mixed vespids, wasp, and honeybee. At least 30 cases of severe allergic reactions to horsefly allergy (family Tabanidae) have been recorded; however, this is thought to be underreported secondary to poor diagnostics and lack of awareness. Clinically, a co-existence of anaphylaxis to horsefly and hymenoptera has been reported. Tab y 2 (a hyaluronidase) and Tab y 5 (antigen 5) have been identified as potential allergen proteins from the saliva of the horsefly as well as wasp venom which supports evidence of horsefly-wasp syndrome. Given the patient's occupational risk, lack of specific immunotherapy for horsefly allergy, and suspected cross reactivity between the wasp and horsefly, VIT for wasp should be considered as a scientifically plausible but limited treatment option for horsefly allergy.
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