Side-effects of insect venom immunotherapy: results from an EAACI multicenter study. European Academy of Allergology and Clinical Immunology

BACKGROUND: The effect of venom immunotherapy (VIT) is well documented, but fear of systemic side-effects (SE) may prevent its use. The study aimed to analyze the character and frequency of SE and risk factors. METHODS: In a prospective study, 19 European centers included patients starting on VIT for systemic reactions to insect stings. Various dose regimens were applied. RESULTS: Data from 840 patients with a total of 26 601 injections were obtained. Seventy-one percent were treated with Vespula-venom extract and 27% with honeybee-venom extract. Twenty percent of patients had SE corresponding to 1.9% of injections during dose increase and 0.5% during the maintenance phase. The vast majority of the 280 reactions were mild: only one-third required medical treatment. Injected or inhaled adrenaline was applied in six patients, of whom only one had a drop in blood pressure and collapse. Female sex, bee-venom extract, and rapid dose increase, but not severity of insect sting reactions, increased the risk of SE. The severity of SE was less in males but was not related to age, treatment phase, species of insect, or severity of insect sting reactions. CONCLUSIONS: The frequency of SE was low, and the majority of these could be managed without treatment. Risk was increased in females, in bee-venom-treated patients, and in those with rapid dose increase.     

Epidemiology of allergic reactions to hymenoptera stings in Irish school children

Jennings A, Duggan E, Perry IJ, Hourihane JO’B. Epidemiology of allergic reactions to hymenoptera stings in Irish school children.
Pediatr Allergy Immunol 2010: 21: 1166–1170.
© 2010 John Wiley & Sons A/S The aim of this was to study generate the first epidemiological data regarding the prevalence of hymenoptera allergy among school children in Ireland. Questionnaires, including six sting‐specific questions ( 1 ), were distributed to the parents of primary school children aged 6–8 and 11–13, divided equally between rural and urban backgrounds. From 110 schools, 4112 questionnaires were returned. A total of 1544 (37.5%) children had been stung in their lifetime. Among the total, 5.8% of children stung experienced a large local reaction, 3.4% had a mild (cutaneous) systemic reaction (MSR) and 0.8% experienced a moderate/severe systemic reaction (SSR); these figures respectively represent 2.2%, 1.3% and 0.2% of the total study group. On logistic regression analysis, older children and rural children were at a higher risk of being stung (OR 1.7; 95% CI 1.4–2.; OR 1.6; 95% CI 1.4–1.8 respectively). Rural dwellers and asthma sufferers were more likely to experience an SSR (OR 4.3; 95% CI 1.4–13.5 and OR 2.8; 95% CI 1.8–4.3, respectively). Hymenoptera stings are more common in rural than urban dwelling Irish children. Asthma imparted a greater risk of SSR in this study population. Severe reactions are unusual overall, occurring in <1% of those stung, a lower prevalence than in Israeli teenagers but in keeping with other European reports relating to young children.     

犬咬伤患者心理卫生状况的随访研究

目的探讨犬咬伤患者的心理卫生状况及其在短期内的变化。方法选用中文版患者健康问卷（PHQ）,在对659例犬咬伤患者常规处理同时,进行心理状态问卷测评,完成随访者613例,其中男368例,女245例,平均年龄（36±14）岁。结果613例患者在初次就诊时均具有轻度或中度躯体症状群（PHQ-15）表现;4周后评分仍有78．0％（478／613）患者存在轻度躯体症状群表现,但中等程度者比例降至3．7％（23／613）。初诊时24．8％（152／613）存在抑郁症状群,4周后随访10．0％（61／613）的患者仍有抑郁症状存在。初诊时46．3％（284／613）有焦虑症状存在,4周后42．1％（258／613）的患者仍存在有轻度焦虑症状群表现,但中等程度者为1．5％（9／613）。结论在犬咬伤患者中心理卫生问题普遍存在且持续一定时间,PHQ可用来检测患者存在的心理症状。     

Scorpion envenoming in the North of Mali (West Africa): Epidemiological, clinical and therapeutic aspects

Scorpion envenomation remains a poorly known problem in sub-Saharan Africa, particularly in Mali, where the incidence is high in Northern area of the country (Sahara desert). We conducted a prospective study in two district health centers, Kidal and Tessalit (North-east of Mali), to describe the epidemiological, clinical and therapeutic features of scorpion stings. This study consisted of an exhaustive follow-up from admission to discharge of all patients stung by scorpions. Of a total of 282 cases recorded during one year, 207 (73.4%) occurred in Kidal, and the remaining 75 (26.6%) took place in Tessalit. The annual incidence was significantly higher in Tessalit (437 cases/100 000 population/year) than in Kidal (243 cases/100,000 population/year) (p < 10⁻⁶). Two hundred two (71.6%) stings occurred inside human dwellings, 142 (50.4%) during sleeping/resting, especially in August. One hundred ninety-one (67.7%) were on the lower extremities. Nocturnal stings, 168 (59.6%), occurred more often than diurnal stings, 114 (40.4%). Most patients, 163 (57.8%), were admitted less than 1 h after being stung. Local pain at the sting site was the common primary complaint. However, moderate and severe clinical signs were significantly higher in children than in adults (p < 0.05). The death rate (3.9%) was higher in children (3.5%) than in adults (0.3%) (p = 8.10⁻⁶; RR = 0.90 [IC: 0.84-0.06]). Of the 22 scorpion species identified, 13 (59.1%) were Leiurus quinquestriiatus, 8 (36.4%) were Androctonus amoreuxi, and 1 (4.5%) specimen was Buthiscus bicalcaratus. From these species, L. quinquestriiatus and A. amoreuxi were responsible of stings. The medical treatment was only symptomatic, and one hundred twenty-eight (45.3%) patients received traditional remedies before seeking medical attention. Our findings suggest that scorpion stings are common in the north of Mali and are a significant threat to human health.     

A case of Tinea nigra associated to a bite from a European rabbit (Oryctolagus cuniculus,Leporidae): the role of dermoscopy in diagnosis

We report a case of Tinea nigra in an adolescent living in Itapema, Santa Catarina, Brazil, who presented a hyperchromic macule on the palm of the left hand, close to another erythematous macule caused by a rabbit bite. The patient received guidance on accidents and animal bites and evolved well treated with topical butenafine for the dermatomycosis. The authors also highlight the efficacy of the dermoscopic exam in diagnosing Tinea nigra with animal bite lesions and other traumas.     

A simple technique for milking the venom of a small parasitic wasp, Melittobia digitata (Hymenoptera: Eulophidae).

We describe a simple method for obtaining good a quantity of pure venom from a small parasitoid wasp, Melittobia digitata. Crushing the insect's head causes venom to be extruded from the ovipositor that dries rapidly as it is collected onto an insect pin. This technique may be applicable to other parasitic Hymenoptera.     

Sonographic Appearance of Angioedema in Local Allergic Reactions to Insect Bites and Stings

Soft tissue infections and angioedema from insect bites and stings may be difficult to differentiate by inspection. We present sonographic findings of 4 cases of soft tissue swelling from insect bites and stings suggestive of angioedema. Sonographic features of soft tissue angioedema consist of thickened subcutaneous tissue layers with multiple linear, horizontal, striated, and hypoechoic lines following the tissue planes between soft tissue layers. In addition to the history and physical examination, sonographic findings may assist in differentiating between local allergic reactions and cellulitis in patients with insect bites and stings. Further study is warranted for clinical application.     

A comparative study of IgG subclass antibodies in patients allergic to wasp or bee venom

IgG1 and IgG4 antivenom antibody responses were compared in groups of patients who had experienced systemic reactions to wasp ( Vespula spp.) or bee stings. Pretreatment serum IgG4 antibody levels were low in both groups, but IgG4 antibodies were significantly raised in bee-allergic patients ( P <0.002), probably reflecting their greater exposure to stings than wasp-reactive patients. No direct or indirect relationships were found, in untreated bee or wasp patients, between IgG1, IgG4, or IgE antibody levels and the severity of a patient's last systemic reaction to a sting. After a 12-week course of venom immunotherapy (VIT), IgG1 antibodies increased significantly only in wasp-sensitive patients ( P <0.001), although both groups responded with marked increases in venom-specific IgG4 ( P <0.01). Wasp-allergic subjects who responded to VIT with high production of specific IgG4 showed the greatest increases (pre- to post-VIT) in IgE antibodies (P<0.05). This group also demonstrated a direct correlation ( P <0.05) between post-VIT levels of IgE and IgG1 antibodies, a finding contrary to an IgE-immunoregulatory role for IgG 1. High levels of venom-specific IgG1 alone, or in combination with IgG4, were not protective in three patients who suffered repeated adverse reactions to bee VIT, showing that absolute levels of IgG subclass antivaenom antibodies are not reliably indicative of clinical responsiveness in individual patients.     

Is hot water immersion an effective treatment for marine envenomation?

Envenomation by marine creatures is common. As more people dive and snorkel for leisure, the incidence of envenomation injuries presenting to emergency departments has increased. Although most serious envenomations occur in the temperate or tropical waters of the Indo-Pacific region, North American and European waters also provide a habitat for many stinging creatures. Marine envenomations can be classified as either surface stings or puncture wounds. Antivenom is available for a limited number of specific marine creatures. Various other treatments such as vinegar, fig juice, boiled cactus, heated stones, hot urine, hot water, and ice have been proposed, although many have little scientific basis. The use of heat therapies, previously reserved for penetrating fish spine injuries, has been suggested as treatment for an increasing variety of marine envenomation. This paper reviews the evidence for the effectiveness of hot water immersion (HWI) and other heat therapies in the management of patients presenting with pain due to marine envenomation.