Dermoscopy as an auxiliary method in the diagnosis of social wasp (Hymenoptera,Vespidae) stings

We describe the case of a 32-year-old male patient that sought medical treatment complaining of severe pain in his second and third right-hand fingers. The symptoms had started two hours before. The hypotheses of spider bite, scorpion or insect sting and injury caused by a foreign body were considered in the differential diagnoses. On dermoscopy, two foreign bodies were identified on his skin. After extraction, we concluded that they were wasp stingers.     

Facial dog bite injuries in children: A case report

IntroductionDog bites are common and can affect victims of different ages, from children to the elderly. Injuries are usually located in different body regions, including head and face. The treatment of choice for injuries is the suture of the lesion, accompanied by antibiotic therapy and tetanus and anti-rabies vaccination.Presentation of caseAn 11-year-old male black patient was admitted to the Surgery and Maxillo-Facial Traumatology Service, on an urgent basis, victim of domestic animal aggression (dog biting). The child had multiple and extensive lesions on the face, trauma with laceration with loss of substance, involving the left genic region, lower and upper lip, and lower gingival-labial sulcus.DiscussionSmaller children are especially vulnerable to injuries in the craniofacial region due their low stature, propensity to crawl/play on the ground and exploratory behavior. The primary treatment of bites is by means of direct suture, grafting or local flaps, depending on the type of wound and the surgeon's decision, regardless of time elapsed from the attack.ConclusionThis case shows a case of a child patient victim of animal bite, with lesions limited to the region of the face. The patient was followed up for a month and showed good wound healing without any complications.     

Verlaufsparameter zur Hyposensibilisierung bei Hymenopterengiftallergie

Summary: Course criteria were evaluated in 50 patients receiving Hymenoptera venom immunotherapy (11 times honeybee and 42 times wasp) ≥ 3 years. Co‐morbidity included hypertension in 24 % of patients and non‐immunological thyroid dysfunction in 14 %. In one patient therapy had to be discontinuated because of a type‐III reaction to immunotherapy. Another 10 % of patients developed mild anaphylactic reactions after venom injections. Continuation of immunotherapy was possible under premedication with antihistamines. During immunotherapy 22 % of the patients had at least one re‐sting of the allergy inducing Hymeonoptera. Of these 6 % developed again an anaphylactic reaction grade I, in consequence the injection dose of venom was elevated for further immunotherapy. IgE values increased insignificantly at the beginning of immunotherapy and decreased significantly after 2 years of immunotherapy. A significant decrease of reactivity to skin prick and intracutaneous tests was already demonstrated after 1 year of immunotherapy.     

The CD63 basophil activation test in Hymenoptera venom allergy: a prospective study

BACKGROUND: The basophil activation test (BAT), which relies on flow cytometric quantitation of the allergen-induced up-regulation of the granule-associated marker CD63 in peripheral blood basophils, has been suggested to be a useful approach in detecting responsiveness to allergens. The purpose of this study was to establish the usefulness of the BAT with regard to the clinical history and current diagnostic tools in Hymenoptera venom allergy using a prospective study design. METHODS: Fifty-seven consecutive patients allergic to Hymenoptera venom as defined by a systemic reaction after an insect sting, and 30 age- and sex-matched control subjects with a negative history were included. The degree and nature of sensitization was confirmed by skin testing, specific immunoglobulin E (IgE), serum tryptase levels and BAT. In the nonallergic control group only analysis of specific IgE and BAT were performed. Correlation of BAT, skin test and specific IgE, respectively, with the clinical history in the allergic group was termed as sensitivity and in the control group as specificity. RESULTS: Twenty one of 23 (91.3%) bee venom allergic patients and 29 of 34 (85.3%) patients allergic to wasp and hornet venom tested positive in BAT. The overall sensitivity of BAT, specific IgE and skin tests were 87.7, 91.2 and 93.0%, respectively. The overall specificities were 86.7% for BAT and 66.7% for specific IgE. No correlation between the severity of clinical symptoms and the magnitude of basophil activation was observed. CONCLUSION: The BAT seems to be an appropriate method to identify patients allergic to bee or wasp venom with a comparable sensitivity to standard diagnostic regimens. The higher specificity of BAT as compared with specific IgE makes this test a useful tool in the diagnosis of Hymenoptera venom allergy.     

Hymenoptera stings and serum venom-specific IgE in Japanese Pest-control operators

Pest-control operators represent a high occupational risk for Hymenoptera sting and a possibility of Hymenoptera allergic reactions, but the information is not well documented. A history of Hymenoptera stings was found in 118 (59.0%) of 200 Japanese pest-control operators. To evaluate the details of Hymenoptera stings and the factors associated with venom-specific IgE level which indicates Hymenoptera allergy, a questionnaire was administered and serum venom-specific IgE levels were measured in 105 subjects selected from 118 operators. The number of past stings was a mean of 3, and in most cases, they had been stung at only one site on the hand or the head and neck. Systemic reactions to Hymenoptera stings were also less frequent among them (5/105). Venom-specific IgE (to a yellow jacket, a wasp, and a honeybee) was measured by the CAP system, and it was found to be positive in 31.4% of the 105 subjects. The frequency of positive CAP was significantly associated with the following factors: the total serum IgE level (P<0.001), the time interval from the last sting-incident (P<0.001), the number of past stings (P<0.05), the most recent clinical symptoms (P<0.05), and an individual atopic history (P<0.05). Among these 5 factors, the former 4 factors were shown to influence the venom-specific IgE titer in the multiple-regression analysis using a forward-stepwise technique (multiple R=0.708, adjust R²=0.482, P<0.001). In particular, the influences of the total serum IgE level and the time interval were strong. These findings indicate that the frequency of Hymenoptera stings in pest-control operators is not as high as in beekeepers or forestry workers, and that venom-specific IgE is affected mainly by the total serum IgE level and the time interval from the last sting-incident.     

Mastocytosis associated with severe wasp sting anaphylaxis detected by elevated serum mast cell tryptase levels

A markedly elevated serum level of mast cell tryptase (77.6 microg/L; 95th percentile in normals 13.5 microg/L) was detected in a patient treated for 5 years with wasp venom immunotherapy because of severe anaphylaxis following a wasp sting. Retrospective analysis of stored serum samples taken during the course of immunotherapy revealed that the tryptase level had been elevated for at least 3 years. Despite several dermatological examinations, skin changes of mastocytosis had been missed. Re-examination of the patient revealed sparse macules on the thorax and thighs; Darier's sign was negative. Histologically, mast cell accumulation in these lesions was demonstrable. No signs of systemic mastocytosis were detected. The most appropriate diagnosis was telangiectasia macularis eruptiva perstans. Even in patients with highly elevated tryptase levels, mastocytosis may go undiagnosed. As mastocytosis predisposes to severe anaphylaxis, the condition should be looked for in patients with such reactions by clinical examination and measurement of serum tryptase levels.     

Wasp venom immunotherapy changes IgG antibody specificity

Background The evolution of the IgG response during venom immunotherapy (VIT) has been previously investigated in terms of antibody titres and subclasses. Objectives The present work studied the evolution of IgG antibody fine specificity in wasp allergic patients treated with rush VIT. Methods Antibody specificity was evaluated in 51 wasp allergic patients in competitive ELISA using streptavidin biotin technology. Patients were tested before and during specific rush immunotherapy (at 15 days, 6 months, 12 months) and compared with 44 patients treated by venom injections for at least 2 years. Results The capacity of sera to prevent the antigen binding of pooled IgG from allergic patients changed rapidly with mean percentage inhibitions (± sd) falling from 70 ± 11–51 ± 18% after 15 days of treatment (P < 0.001 by one way anova). Similarly, the antigen binding capacity of pooled IgG from VIT patients was differently prevented by sera with mean percentage inhibitions increasing from 37 ± 12–65 ± 8 after 15 days of treatment (P < 0.0001 by one-way anova). Conclusions The immunodominance pattern of IgG epitopes recognized on wasp venom antigens by sera from wasp allergic patients changes soon after initiating rush VIT. Further studies will indicate whether, instead of measuring IgG titres, this marked change could be used as the basis of a new test for monitoring the outcome of VIT.