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CHaPtEr 43 Allergic Reactions to Stinging and Biting Insects 609

5. Ollert M, Blank S. Anaphylaxis to insect venom allergens: role of
Clinical Symptoms molecular diagnostics. Curr Allergy Asthma Rep 2015;15:26.
Local reactions to insect bites may be characterized by immediate 6. Müller U. Insect venoms. In: Ring J, editor. Anaphylaxis, chemical
wheal and flare, or may be delayed, with pruritic erythema and immunol allergy. Basel, Switzerland: Karger; 2010. p. 141–56.
papules developing after 12–24 hours and lasting for days to 7. King TP, Guralnick M. Hymenoptera allergens. In: Lockey R, Ledford D,
editors. Allergens and allergen immunotherapy, vol. 21. 4th ed. (Clinical
weeks; combined reactions can also occur. In delayed and Allergy and Immunology). Boca Raton, FL: Taylor & Francis; 2008. p.
combined reactions, vesicular, bullous, or even necrotic lesions 237–49.
may develop. SRs are much rarer than those to Hymenoptera 8. Grunwald T, Bockisch B, Spillner E, et al. Molecular cloning and
stings. They have, however, occasionally been described, especially expression in insect cells of honeybee venom allergen acid phosphatase
after bites by horseflies (Tabanus spp.) and the kissing bug (Api m 3). J Allergy Clin Immunol 2006;117:848–54.
(Triatoma protracta). 9. Seismann H, Blank S, Braren I, et al. Dissecting cross-reactivity in
Hymenoptera venom allergy by circumvention of a-1,3-core fucosylation.
Allergens Mol Immunol 2010;47:799–808.
The salivary proteins involved have either digestive (amylases, 10. Müller U, Golden DBK, Lockey RF. Byol S. Immunotherapy for
esterases) or hemostatic function (e.g., factor Xa inhibition). Hymenoptera venom hypersensitivity. In: Lockey R, Ledford D, editors.
Allergens and allergen immunotherapy, vol. 21. 4th ed. (Clinical Allergy
Numerous IgE-binding proteins with a molecular weight of and Immunology). Boca Raton, FL: Taylor & Francis; 2008. p. 377–92.
15–81 kDa have been described, especially in the saliva of 11. Mueller HL. Diagnosis and treatment of insect sensitivity. J Asthma Res
mosquitoes, and in horseflies and kissing bugs as well; some 1966;3:331–3.
of these proteins have been cloned. 35 12. Reisman RE. Unusual reactions to insect stings. Curr Opin Allergy Clin
Immunol 2005;5:355–8.
Prevention and Treatment 13. Sturm GJ, Kranzelbinder B, Schuster C, et al. Sensitization to
The application of insect repellents and prophylactic intake of Hymenoptera venoms is common, but systemic sting reactions are rare.
antihistamines can prevent or mitigate outdoor exposure. Screens J Allergy Clin Immunol 2014;133:1635–43.
on windows and doors and mosquito nets over the beds are 14. Graif Y, Confino-Cohen R, Goldberg A. Allergic reactions to insect stings:
effective in homes. Bedbug infestation should be eliminated by Results from a national survey of 10 000 junior high school children in
Israel. J Allergy Clin Immunol 2006;117:1435–9.
using appropriate pesticides; flea infestation of pet animals should 15. Müller U. Bee venom allergy in beekeepers and their family members.
be managed by a veterinarian. Local reactions may be treated Curr Opin Allergy Clin Immunol 2005;5:343–7.
with topical steroids or oral antihistamines. 16. Antonicelli A, Bilò MB, Bonifazi F. Epidemiology of Hymenoptera allergy.
Curr Opin Allergy Clin Immunol 2002;2:341–6.
17. Müller UR, Ring J. When can immunotherapy for insect sting allergy be
ON tHE HOrIZON stopped? J Allergy Clin Immunol Pract 2015;3:324–8.
18. Müller U, Haeberli G. Use of beta-blockers during immunotherapy for
The availability of recombinant venom allergens offers several promising
perspectives for diagnosis and immunotherapy. 5-9 Hymenoptera venom allergy. J Allergy Clin Immunol 2005;115:606–10.
• The specificity of these tests could be considerably improved by using 19. Ruëff F, Przybilla B, Bilò M, et al. Predictors of severe anaphylactic
recombinant cocktails with species-specific major allergens without reactions in patients with hymenoptera venom allergy: importance of
cross-reacting carbohydrate determinants (CCDs) for diagnosis instead baseline serum tryptase. J Allergy Clin Immunol 2009;124:1047–55.
of the whole venom. 20. Sasvary T, Müller U. Fatalities from insect stings in Switzerland 1978 to
• In patients with double-positive diagnostic tests to honeybee and 1987. Schweiz Med Wschr 1994;124:1887–94.
Vespula venom, recombinant species-specific nonglycosylated major 21. Ruëff F, Przybilla B, Müller U, et al. The sting challenge test in
allergens from honeybee and Vespula venom make it possible to dis- Hymenoptera venom allergy. Allergy 1996;51:216–25.
tinguish reliably between true double sensitization and cross-reactivity, 22. Golden DBK, Kagey-Sobotka A, Norman PS, et al. Outcomes of allergy to
an important issue for the choice of venoms for immunotherapy. insect stings in children, with and without venom immunotherapy. N
• Addition of such allergens to therapy solutions can increase the efficacy Engl J Med 2004;351:668–74.
of venom immunotherapy (VIT) with bee venom, as these are lacking 23. Brown SG. Cardiovascular aspects of anaphylaxis: implications for
or insufficiently represented in currently available preparations. treatment and diagnosis. Curr Opin Allergy Clin Immunol
• Allergic side effects of VIT might be reduced by using modified major 2005;5:359–64.
allergens with reduced immunoglobulin E (IgE) binding, but retained 24. Oude Elberink JN, Dubois AE. Quality of life in insect venom allergic
specific T-cell interaction. 36 patients. Curr Opin Allergy Clin Immunol 2003;3:287–93.
25. Frick M, Müller S, Bantleon F, et al. rApi m 3 and rApi m 10 improve
detection of honey bee sensitization in Hymenoptera venom-allergic
Please check your eBook at https://expertconsult.inkling.com/ patients with double sensitization to honey bee and yellow jacket venom.
for self-assessment questions. See inside cover for registration Allergy 2015;70:1665–8.
details. 26. Golden DBK, Kagey-Sobotka A, Norman PS, et al. Insect sting allergy
with negative venom skin test responses. J Allergy Clin Immunol
REFERENCES 2001;107:897–901.
27. Hemmer W, Focke M, Kolarich D, et al. Antibody binding to venom
1. Müller U. Insect sting allergy. Stuttgart, Germany: Gustav Fischer Verlag; carbohydrates is a frequent cause for double positivity to honey bee and
1990. yellow jacket venom in patients with stinging insect allergy. J Allergy Clin
2. Bilò MB, Ruëff F, Mosbech H, et al. Diagnosis of Hymenoptera venom Immunol 2001;108:1045–52.
allergy. Allergy 2005;60:1339–49. 28. Müller U, Johansen N, Petersen A, et al. Hymenoptera venom allergy:
3. Hoffmann DR. Ant venoms. Curr Opin Allergy Clin Immunol analysis of double positivity to honey bee and Vespula venom by
2010;10:342–6. estimation of species-specific major allergens Api m1 and Ves v5. Allergy
4. Brown SGA, Franks RW, Baldo BA, et al. Prevalence, severity, and natural 2009;64:543–8.
history of jack jumper ant venom allergy in Tasmania. J Allergy Clin 29. Ruëff F, Vos B, Elberink JO, et al. Predictors of clinical effectiveness of
Immunol 2003;111:187–92. Hymenoptera venom immunotherapy. Clin Exp Allergy 2014;44:736–46.