1
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Ruwanpathirana P, Priyankara D. Clinical manifestations of wasp stings: a case report and a review of literature. Trop Med Health 2022; 50:82. [PMID: 36307881 PMCID: PMC9615201 DOI: 10.1186/s41182-022-00475-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Wasp stinging, a neglected tropical entity can have a myriad of local and systemic effects. We present a case of multi-organ injury following multiple wasp stings and a review of literature on the systemic manifestations of wasp stings.
Case presentation A 48-year-old Sri Lankan male who suffered multiple wasp stings, developed an anaphylactic shock with respiratory failure, which was treated with adrenaline and mechanical ventilation. Within the next 2 days the patient developed acute fulminant hepatitis, stage III acute kidney injury, rhabdomyolysis, haemolysis and thrombocytopenia. The patient was treated in the intensive care unit with ionopressors and continuous renal replacement therapy (CRRT). Haemoadsorbant therapy was used in adjunct with CRRT. There was a gradual recovery of the organ functions over the 1st week. However, the patient succumbed to fungal sepsis on the 16th day despite treatment. We conducted a literature review to identify the various clinical manifestations of wasp stinging. Wasp venom contains enzymes, amines, peptides and other compounds. These proteins can cause type 1 hypersensitive reactions ranging from local skin irritation to anaphylactic shock. Furthermore, the toxins can cause direct organ injury or delayed hypersensitivity reactions. The commonly affected organs are the kidneys, liver, and muscles. The effect on the haematological system manifests as coagulopathy and/or cytopenia. The heart, nervous system, lungs, intestines and skin can be affected rarely. Treatment is mainly supportive. Conclusion In conclusion, wasp envenomation can result in multi-organ injury and attention should be paid in doing further research and establishing evidence-based treatment practices.
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Affiliation(s)
- Pramith Ruwanpathirana
- Medical Intensive Unit, National Hospital Sri Lanka, 435/11, Thimbirigasyaya Road, Colombo 05, Sri Lanka.
| | - Dilshan Priyankara
- Medical Intensive Unit, National Hospital Sri Lanka, 435/11, Thimbirigasyaya Road, Colombo 05, Sri Lanka
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2
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Yang S, Wellington J, Chen J, Regenhardt RW, Chen AY, Li G, Yan Z, Fu P, Hu Z, Chen Y. Cerebral infarction following bee stings: Case report and literature review. Transl Neurosci 2022; 13:163-171. [PMID: 35860807 PMCID: PMC9267306 DOI: 10.1515/tnsci-2022-0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background To date, only 25 cases of cerebral infarction following a bee or wasp sting have been reported. Due to its rarity, undefined pathogenesis, and unique clinical features, we report a case of a 62-year-old man with progressive cerebral infarction following bee stings, possibly related to vasospasm. Furthermore, we review relevant literature on stroke following bee or wasp stings. Case presentation A 62-year-old retired male presented with progressive ischemic stroke after bee stings to the ear and face. Initial magnetic resonance imaging of the brain showed small punctate infarcts in the left medulla oblongata. Head and neck computed tomography angiography showed significant stenosis in the basilar artery and occlusion in the left V4 vertebral artery. The patient received intravenous alteplase (0.9 mg/kg) without symptomatic improvement. Digital subtraction angiography later demonstrated additional near occlusion in the left posterior cerebral artery (PCA). Thrombectomy was considered initially but was aborted due to hemodynamic instability. Repeated CT brain after 24 h showed acute infarcts in the left parieto-occipital region and left thalamus. The near occluded PCA was found to be patent again on magnetic resonance angiography (MRA) 25 days later. This reversibility suggests that vasospasm may have been the underlying mechanism. Unfortunately, the patient had persistent significant neurological deficits after rehabilitation one year later. Conclusion Cerebral infarction following bee stings is rare. There are several proposed pathophysiological mechanisms. While the natural course of this phenomenon is not well characterized, early diagnosis and treatment are essential. Furthermore, it is important to establish standardized care procedures for this unique entity.
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Affiliation(s)
- Shuiquan Yang
- Department of Neurology and National Advanced Stroke Center, Key Discipline of Traditional Chinese Medicine of Guangdong Province, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Jack Wellington
- School of Medicine, Cardiff University, Wales, United Kingdom
| | - Juanmei Chen
- The Second Clinical College, Guangzhou Medical University, Guangzhou, China
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Alex Y Chen
- Department of Neurology, University Hospital, Case Western Reserve University, Cleveland, United States of America
| | - Guilan Li
- Department of Neurology and National Advanced Stroke Center, Key Discipline of Traditional Chinese Medicine of Guangdong Province, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Zile Yan
- Department of Neurology and National Advanced Stroke Center, Key Discipline of Traditional Chinese Medicine of Guangdong Province, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Pingzhong Fu
- Department of Radiology, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Zhaohui Hu
- Medical Department and National Advanced Stroke Center, Key Discipline of Traditional Chinese Medicine of Guangdong Province, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Yimin Chen
- Department of Neurology and National Advanced Stroke Center, Key Discipline of Traditional Chinese Medicine of Guangdong Province, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
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3
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Castagnoli R, Giovannini M, Mori F, Barni S, Pecoraro L, Arasi S, Saretta F, Mastrorilli C, Liotti L, Caminiti L, Sturm GJ, Marseglia GL, Novembre E. Unusual Reactions to Hymenoptera Stings: Current Knowledge and Unmet Needs in the Pediatric Population. Front Med (Lausanne) 2021; 8:717290. [PMID: 34901051 PMCID: PMC8661053 DOI: 10.3389/fmed.2021.717290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
Hymenoptera stings are generally well-tolerated and usually cause limited local reactions, characterized by self-resolving erythema and edema associated with pain. However, Hymenoptera stings can induce immediate and delayed hypersensitivity reactions. In addition to these manifestations, unusual reactions to Hymenoptera stings have been reported. The latter are defined as unusual because of their atypical characteristics. They may differ from classical hypersensitivity reactions due to the stings' particular localization and the unusual involvement of one or more specific organs. Although unusual reactions to Hymenoptera stings are infrequent, it is essential for clinicians to know the possible related clinical manifestations. Here, we review the available literature and propose a diagnostic and management algorithm. At present, there are no defined guidelines for most of the unusual reactions to Hymenoptera stings, which should be managed in a tailored way according to the specifical clinical manifestations presented by the patients. Further studies are needed to better define these conditions and the underlying pathogenetic mechanisms to improve the diagnostic and therapeutic approach.
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Affiliation(s)
- Riccardo Castagnoli
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Luca Pecoraro
- Department of Medicine, University of Verona, Policlinico GB Rossi, Verona, Italy.,Pediatric Unit, ASST Mantua, Mantua, Italy
| | - Stefania Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Carla Mastrorilli
- Pediatric Unit and Emergency, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, Bari, Italy
| | - Lucia Liotti
- Department of Pediatrics, Salesi Children's Hospital, AOU Ospedali Riuniti Ancona, Ancona, Italy
| | - Lucia Caminiti
- Department of Human Pathology in Adult and Development Age "Gaetano Barresi," Allergy Unit, Department of Pediatrics, AOU Policlinico Gaetano Martino, Messina, Italy
| | - Gunter Johannes Sturm
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.,Allergy Outpatient Clinic Reumannplatz, Vienna, Austria
| | - Gian Luigi Marseglia
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Elio Novembre
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
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4
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Vidal C. The Asian wasp Vespa velutina nigrithorax: Entomological and allergological characteristics. Clin Exp Allergy 2021; 52:489-498. [PMID: 34822191 DOI: 10.1111/cea.14063] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/31/2021] [Accepted: 11/22/2021] [Indexed: 12/12/2022]
Abstract
The yellow-legged or Asian wasp (Vespa velutina nigrithorax) has spread rapidly across Europe since its first introduction in France, in 2004. Originally from South-East Asia, it is considered an invasive species outside its native region. Apart from the ecological and economic implications of its presence, it may cause health problems to humans due to the toxic and allergenic components of its venom. Vespa velutina nigrithorax has become the most prevalent cause of anaphylaxis due to Hymenoptera venom in some regions of Spain. Although sIgE against both antigen 5 (Vesp v 5) and A1-phospholipase (Vesp v 1) has been detected in these patients, only Vesp v 5 may be considered a dominant allergen. Interestingly, Vesp v 1 appears to be a glycosylated allergen different from A1-phospholipases from other species. Inhibition studies suggest that Vespula spp venom could behave as primary sensitizer. Besides, changes in sIgE and sIgG4 during Vespula venom immunotherapy in patients with anaphylaxis due to V. velutina support the use of Vespula venom extracts to treat these patients. The purpose of this review is to explore the biological behaviour of V. velutina and to summarize the current knowledge of the allergic reactions provoked by this wasp.
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Affiliation(s)
- Carmen Vidal
- Allergy Department, Complejo Hospitalario Universitario de Santiago, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
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5
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Can C, Yazicioglu M, Gokalp S, Ozkayin N. Parvovirus Infection in a Child Presenting with Erythema Multiforme and Vasculitis after a Yellow Jacket Bee Sting. J Trop Pediatr 2021; 67:5869963. [PMID: 32856696 DOI: 10.1093/tropej/fmaa043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Parvovirus B19 has a wide spectrum of clinical manifestations. Erythema multiforme and vasculitis are rarely reported with parvovirus B19 infections. Reactions to insect stings can range from local swelling to life-threatening systemic reactions. There have been rare reports of unusual reactions, such as vasculitis, occurring in a temporal relationship with insect stings. We report an 8-year-old patient having Parvovirus B-19-related erythema multiforme and vasculitis after a yellow jacket bee sting.
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Affiliation(s)
- Ceren Can
- Department of Pediatric Allergy and Immunology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Mehtap Yazicioglu
- Department of Pediatric Allergy and Immunology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Selman Gokalp
- Department of Pediatric Cardiology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Nese Ozkayin
- Department of Pediatric Nephrology, Trakya University Faculty of Medicine, Edirne, Turkey
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6
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New Biomarkers of Hymenoptera Venom Allergy in a Group of Inflammation Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084011. [PMID: 33920429 PMCID: PMC8069624 DOI: 10.3390/ijerph18084011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 01/30/2023]
Abstract
Hymenoptera venom allergy significantly affects the quality of life. Due to the divergences in the results of the available test and clinical symptoms of patients, the current widely applied diagnostic methods are often insufficient to classify patients for venom immunotherapy (VIT). Therefore it is still needed to search for new, more precise, and accurate diagnostic methods. Hence, this research aimed to discover new biomarkers of Hymenoptera venom allergy in a group of inflammation factors using set of multi-marker Bioplex panel. The adoption of a novel methodology based on Luminex/xMAP enabled simultaneous determination of serum levels of 37 different inflammatory proteins in one experiment. The study involved 21 patients allergic to wasp and/or honey bee venom and 42 healthy participants. According to univariate and multivariate statistics, soluble CD30/tumor necrosis factor receptor superfamily, member 8 (sCD30/TNFRSF8), and the soluble tumor necrosis factor receptor 1 (sTNF-R1) may be considered as effective prognostic factors, their circulating levels were significantly decreased in the allergy group (p-value < 0.05; the Area Under the Curve (AUC) ~0.7; Variable Importance in Projection (VIP) scores >1.2). The obtained results shed new light on the allergic inflammatory response and may contribute to modification and improvement of the diagnostic and monitoring methods. Further, large-scale studies are still needed to explain mechanisms of action of studied compounds and to definitively prove their usefulness in clinical practice.
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7
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Sung SH, Kim JW, Han JE, Shin BC, Park JK, Lee G. Animal Venom for Medical Usage in Pharmacopuncture in Korean Medicine: Current Status and Clinical Implication. Toxins (Basel) 2021; 13:toxins13020105. [PMID: 33535603 PMCID: PMC7912904 DOI: 10.3390/toxins13020105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 02/08/2023] Open
Abstract
Animal venoms, widespread throughout the world, are complex mixtures, the composition of which depends on the venom-producing species. The objective of this study was to contribute to the development of animal venom-based medicines by investigating the use of animal venom pharmacopuncture in Korean medicine (KM) institutions. We surveyed 256 public health centers from 1 through 31 October 2019 as guided by the Ministry of Health and Welfare (MoHW). A questionnaire developed by an expert group was distributed and collected for statistical analysis. The survey identified three types of animal venom-based pharmacopuncture: bee, snake, and toad venoms. The medications are based on a single animal venom ingredient and produced in 11 external herbal dispensaries (EHDs). Each animal venom is processed, refined, and freeze-dried in a cleanroom to produce a powder formulation that is later measured, diluted, filtered, filled, sealed, sterilized, and packaged as pharmacopuncture injections used in KM institutions. Bee venom therapy is effective in treating musculoskeletal pain, snake venom therapy is effective in controlling bleeding during surgery, and toad venom therapy is effective in cancer treatment. The study suggests that bee, snake, and toad venoms could be used in medical institutions and have the potential for drug development.
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Affiliation(s)
- Soo-Hyun Sung
- Department of Policy Development, National Development Institute of Korean Medicine, Seoul 04554, Korea; (S.-H.S.); (J.-W.K.); (J.-E.H.)
| | - Ji-Won Kim
- Department of Policy Development, National Development Institute of Korean Medicine, Seoul 04554, Korea; (S.-H.S.); (J.-W.K.); (J.-E.H.)
| | - Ji-Eun Han
- Department of Policy Development, National Development Institute of Korean Medicine, Seoul 04554, Korea; (S.-H.S.); (J.-W.K.); (J.-E.H.)
| | - Byung-Cheul Shin
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan 50612, Korea; (B.-C.S.); (J.-K.P.)
| | - Jang-Kyung Park
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan 50612, Korea; (B.-C.S.); (J.-K.P.)
| | - Gihyun Lee
- College of Korean Medicine, Dongshin University, Naju 58245, Korea
- Correspondence:
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8
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Akgul MH, Bagırov E. Brachial artery thrombosis following bee sting, case report. Int J Surg Case Rep 2020; 78:184-186. [PMID: 33360332 PMCID: PMC7771038 DOI: 10.1016/j.ijscr.2020.11.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/29/2020] [Accepted: 11/29/2020] [Indexed: 11/28/2022] Open
Abstract
Bee sting are the most common insect emergencies. Often bee stings occur only with local allergic reactions. A very rare case of brachial artery thrombosis after a honey bee sting is presented.
Introduction Bee stings are the most common among insect emergencies. Presentation of case We present a 47-year-old male patient who was admitted to the emergency department with complaints of pallor, chills, numbness and bruising on the left palm one hour after a bee sting on his left leg, and a very rare case of brachial artery stenosis in Dopler ultrasonography. Discussion Often bee stings occur only with local allergic reactions; sometimes it can also cause myocardial infarction, pulmonary edema, bleeding, hemolytic anemia, and kidney disease and neurological manifestations. Side effects are generally thought to be related to the dose of this venom in these patients who are admitted to the emergency room with a bruise extending from the left hand to the arm after bee bites. Conclusion With this case presented, we wanted to emphasize that thrombosis may occur due to bee stings, albeit rarely, and doctors in emergency departments should recognize these very rare cases.
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Affiliation(s)
- Mehmet Huseyin Akgul
- Department of Neurosurgery, Kırıkkale State Hospital, Yahsihan, Kırıkkale, Turkey.
| | - Eldar Bagırov
- Department of Cardiovasculer Surgery, Kırıkkale State Hospital, Yahsihan, Kırıkkale, Turkey
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9
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Blank S, Grosch J, Ollert M, Bilò MB. Precision Medicine in Hymenoptera Venom Allergy: Diagnostics, Biomarkers, and Therapy of Different Endotypes and Phenotypes. Front Immunol 2020; 11:579409. [PMID: 33193378 PMCID: PMC7643016 DOI: 10.3389/fimmu.2020.579409] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022] Open
Abstract
Allergic reactions to stings of Hymenoptera species may be severe and are potentially fatal deviations of the immunological response observed in healthy individuals. However, venom-specific immunotherapy (VIT) is an immunomodulatory approach able to cure venom allergy in the majority of affected patients. An appropriate therapeutic intervention and the efficacy of VIT not only depend on a conclusive diagnosis, but might also be influenced by the patient-specific manifestation of the disease. As with other diseases, it should be borne in mind that there are different endotypes and phenotypes of venom allergy, each of which require a patient-tailored disease management and treatment scheme. Reviewed here are different endotypes of sting reactions such as IgE-mediated allergy, asymptomatic sensitization or a simultaneous presence of venom allergy and mast cell disorders including particular considerations for diagnosis and therapy. Additionally, phenotypical manifestations of venom allergy, as e.g. differences in age of onset and disease severity, multiple sensitization or patients unsusceptible to therapy, are described. Moreover, biomarkers and diagnostic strategies that might reflect the immunological status of the patient and their value for therapeutic guidance are discussed. Taken together, the increasing knowledge of different disease manifestations in venom hypersensitivity and the growing availability of diagnostic tools open new options for the classification of venom allergy and, hence, for personalized medical approaches and precision medicine in Hymenoptera venom allergy.
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Affiliation(s)
- Simon Blank
- Center of Allergy and Environment (ZAUM), Technical University of Munich, School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Johannes Grosch
- Center of Allergy and Environment (ZAUM), Technical University of Munich, School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health (LIH), Esch-sur-Alzette, Luxembourg.,Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
| | - Maria Beatrice Bilò
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.,Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Ancona, Italy
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10
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Golden DBK, Carter MC. Insect Sting Anaphylaxis-Or Mastocytosis-Or Something Else? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 7:1117-1123. [PMID: 30961837 DOI: 10.1016/j.jaip.2019.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 12/18/2022]
Abstract
Insect sting anaphylaxis and mast cell disorders are intertwined in a specific and unusual way. There may be specific subsets of clonal mast cell disorders that are predisposed to sting anaphylaxis. The clinical characteristics of the sting reactions should raise suspicion of underlying mastocytosis (eg, hypotension without hives especially in a male). A baseline serum tryptase level is helpful in the evaluation of patients with insect sting anaphylaxis because it correlates with important risks for these patients, and they have a high frequency of abnormally elevated baseline levels. Elevated baseline serum tryptase level has been reported to correlate with clonal mast cell disease in patients with insect sting anaphylaxis but may also indicate one of several possible underlying syndromes, including mast cell activation syndrome (MCAS), familial hypertryptasemia, and idiopathic anaphylaxis. There is some overlap in these conditions, so it is important to evaluate the clinical pattern at presentation as well as laboratory markers, and to consider bone marrow biopsy to make a final and specific diagnosis of clonal mast cell disease. The presence of venom-IgE does not prove that the patient's previous sting reactions were IgE-mediated, but even low levels of venom-IgE in patients with mastocytosis predispose to severe sting anaphylaxis. Evaluation of all these possible factors will affect the recommendation for venom immunotherapy.
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Affiliation(s)
- David B K Golden
- Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Md.
| | - Melody C Carter
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
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11
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Pansare M, Seth D, Kamat A, Kamat D. Summer Buzz: All You Need to Know about Insect Sting Allergies. Pediatr Rev 2020; 41:348-356. [PMID: 32611799 DOI: 10.1542/pir.2018-0358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Insect stings can generate a range of immune and clinical reactions. Most reactions are local and self-limiting. Allergic reactions to insect stings can occur at all ages, with or without previous stings. Individuals with a history of anaphylaxis carry a significant risk of life-threatening anaphylaxis with future stings. Health-care providers are often unaware of the tremendous clinical benefits of venom immunotherapy for these select patients. Scientific knowledge about the natural history, risk factors, and optimal therapy for insect sting allergies has improved considerably in recent years.
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Affiliation(s)
| | - Divya Seth
- Children's Hospital of Michigan, Detroit, MI
| | - Aarti Kamat
- Helen Devos Children's Hospital, Grand Rapids, MI
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12
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Jakubovic BD, Jagdis A, Trinkaus M, Lang A, Chang A, Rastin T, Castells M, Betschel S. Recurrent neurologic symptoms complicating venom immunotherapy in a patient with systemic mastocytosis and severe Hymenoptera allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:780-782. [PMID: 31415904 DOI: 10.1016/j.jaip.2019.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Baruch D Jakubovic
- Division of Clinical Immunology & Allergy, Department of Medicine, St Michael's Hospital & University of Toronto, Toronto, ON, Canada.
| | - Amanda Jagdis
- Division of Clinical Immunology & Allergy, Department of Medicine, St Michael's Hospital & University of Toronto, Toronto, ON, Canada
| | - Martina Trinkaus
- Division of Hematology & Oncology, Department of Medicine, St Michael's Hospital & University of Toronto, Toronto, ON, Canada
| | - Anthony Lang
- Edmund J. Safra Program in Parkinson's Disease, Division of Neurology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anna Chang
- Edmund J. Safra Program in Parkinson's Disease, Division of Neurology, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan
| | - Tara Rastin
- Edmund J. Safra Program in Parkinson's Disease, Division of Neurology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mariana Castells
- Mastocytosis Center, Brigham & Women's Hospital and Harvard Medical School, Boston, Mass
| | - Stephen Betschel
- Division of Clinical Immunology & Allergy, Department of Medicine, St Michael's Hospital & University of Toronto, Toronto, ON, Canada
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13
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Al-Salam S, Aburawi EH, Al-Hammadi S, Dhanasekaran S, Shafiuallah M, Yasin J, Sudhadevi M, Awwad A, Alper SL, Kazzam EE, Bellou A. Cellular and Immunohistochemical Changes in Anaphylactic Shock Induced in the Ovalbumin-Sensitized Wistar Rat Model. Biomolecules 2019; 9:biom9030101. [PMID: 30871269 PMCID: PMC6468713 DOI: 10.3390/biom9030101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/24/2022] Open
Abstract
Anaphylactic shock (AS) is a life-threatening, multisystem disorder arising from sudden release of mast cell- and basophil-derived mediators into the circulation. In this study, we have used a Wistar rat model to investigate AS-associated histopathologic changes in various organs. Rats were sensitized with ovalbumin (1 mg s.c), and AS was induced by intravenous injection of ovalbumin (1 mg). Experimental groups included nonallergic rats (n = 6) and allergic rats (n = 6). Heart rate and blood pressure were monitored during one hour. Organs were harvested at the end of the experiment and prepared for histologic and immunohistochemical studies. Lung, small bowel mucosa and spleen were found to undergo heavy infiltration by mast cells and eosinophils, with less prominent mast cell infiltration of cardiac tissue. The mast cells in lung, small bowel and spleen exhibited increased expression of tryptase, c-kit and induced nitric oxide synthase (iNOS). Increased expression of endothelial nitric oxide synthase (eNOS) by vascular endothelial cells was noted principally in lung, heart and small bowel wall. The Wistar rat model of AS exhibited accumulation of mast cells and eosinophils in the lung, small bowel, and spleen to a greater extent than in the heart. We conclude that lung and gut are principal inflammatory targets in AS, and likely contribute to the severe hypotension of AS. Targeting nitric oxide (NO) production may help reduce AS mortality.
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Affiliation(s)
- Suhail Al-Salam
- Department of Pathology, College of Medicine & Health Sciences, United Arab Emirates University, AlAin 17666, Abu Dhabi, UAE.
| | - Elhadi H Aburawi
- Department of Paediatrics, College of Medicine & Health Sciences, United Arab Emirates University, AlAin 17666, Abu Dhabi, UAE.
| | - Suleiman Al-Hammadi
- Department of Paediatrics, College of Medicine & Health Sciences, United Arab Emirates University, AlAin 17666, Abu Dhabi, UAE.
| | | | - Mohamed Shafiuallah
- Department of Pharmacology, College of Medicine & Health Sciences, United Arab Emirates University, AlAin 17666, Abu Dhabi, UAE.
| | - Javed Yasin
- Department of Internal Medicine, College of Medicine & Health Sciences, United Arab Emirates University, AlAin 17666, Abu Dhabi, UAE.
| | - Manjusha Sudhadevi
- Department of Pathology, College of Medicine & Health Sciences, United Arab Emirates University, AlAin 17666, Abu Dhabi, UAE.
| | - Aktham Awwad
- Department of Laboratory Medicine, Tawam Hospital, AlAin 15258, Abu Dhabi, UAE.
| | - Seth L Alper
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA 02215, USA.
| | - Elsadig E Kazzam
- Department of Internal Medicine, College of Medicine & Health Sciences, United Arab Emirates University, AlAin 17666, Abu Dhabi, UAE.
| | - Abdelouahab Bellou
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
- Global HealthCare Network & Research Innovation Institute, Brookline, MA 02446, USA.
- International Board of Medicine and Surgery, Tampa, FL 34677, USA.
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14
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Helbling A, Müller UR. Allergic Reactions to Stinging and Biting Insects. Clin Immunol 2019. [DOI: 10.1016/b978-0-7020-6896-6.00043-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Kausar MA. A review on Respiratory allergy caused by insects. Bioinformation 2018; 14:540-553. [PMID: 31223213 PMCID: PMC6563666 DOI: 10.6026/97320630014540] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 02/08/2023] Open
Abstract
Hypersensitivity or allergy encompasses a wide range of immunological reactions that generally have adverse consequences involving one or many organ systems of the body. Allergens are usually glycoprotein or chemically complex low molecular weight substances. The common allergens include pollen, fungal spores, house dust mite and house dust, animal danders, drugs, foods, insect emanations, and detritus, etc. Information on the role of insects in respiratory allergy is increasing in the literature. There are about 30 million living species of insects. These insects can broadly be classified as stinging insects, biting insects and non-stinging and non-biting insects. All materials form insets namely wings, scales, saliva; dried feces and venom can cause allergic diseases, such as rhinitis, conjunctivitis, asthma and urticaria. There are wide varieties of insects such as moths, butterflies, bees, wasps, hornets, yellow jackets, flies, beetles, cockroaches, and mosquitoes. Exposure to emanations and detritus of these insects may lead to several allergies in some genetically predisposed individuals. Therefore, it is of interest to review allergies caused by various insect's stings and bites and their adverse effect on the human body.
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Affiliation(s)
- Mohd Adnan Kausar
- Department of Biochemistry, College of Medicine, University of Hail, Hail, Saudi Arabia, KSA
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16
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Abstract
Insect sting-related envenomation rarely produces seizures. We present a patient with confusion and seizures that began 24 hours after a yellow jacket (wasp) sting. Given the rapid onset and resolution of symptoms, as well as accompanying dermatological and orbital features, and the lack of any infectious or structural abnormalities identified, the toxic effect of the wasp venom (and related anaphylaxis reaction) was believed to be the cause of his presentation.
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Affiliation(s)
- Ghulam Abbas Kharal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Ryan Darby
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Adam B Cohen
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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17
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Golden DBK, Demain J, Freeman T, Graft D, Tankersley M, Tracy J, Blessing-Moore J, Bernstein D, Dinakar C, Greenhawt M, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Wallace D. Stinging insect hypersensitivity: A practice parameter update 2016. Ann Allergy Asthma Immunol 2017; 118:28-54. [PMID: 28007086 DOI: 10.1016/j.anai.2016.10.031] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
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18
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Düzenli U, Bozan N, Ayral A, Yalınkılıç A, Kıroğlu AF. A honey bee can threat ear: Sudden sensorineural hearing loss. Am J Emerg Med 2017; 35:1788.e1-1788.e3. [PMID: 28818308 DOI: 10.1016/j.ajem.2017.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022] Open
Abstract
Sudden sensorineural hearing loss is an otologic emergency. Many etiological factors can lead to this pathology. Honey bee (Apis mellifera) sting may lead to local and systemic reactions due to sensitization of the patient. In this paper we described a sudden sensorineural hearing loss occurred after honey bee sting.
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Affiliation(s)
- Ufuk Düzenli
- Yüzüncü Yıl University, Faculty of Medicine, Department of Otorhinolaryngology, Van, Turkey.
| | - Nazım Bozan
- Yüzüncü Yıl University, Faculty of Medicine, Department of Otorhinolaryngology, Van, Turkey
| | - Abdurrahman Ayral
- Yüzüncü Yıl University, Faculty of Medicine, Department of Otorhinolaryngology, Van, Turkey
| | - Abdülaziz Yalınkılıç
- Yüzüncü Yıl University, Faculty of Medicine, Department of Otorhinolaryngology, Van, Turkey
| | - Ahmet Faruk Kıroğlu
- Yüzüncü Yıl University, Faculty of Medicine, Department of Otorhinolaryngology, Van, Turkey
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19
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Guilarte M, Sala-Cunill A, Luengo O, Labrador-Horrillo M, Cardona V. The Mast Cell, Contact, and Coagulation System Connection in Anaphylaxis. Front Immunol 2017; 8:846. [PMID: 28798744 PMCID: PMC5526842 DOI: 10.3389/fimmu.2017.00846] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/05/2017] [Indexed: 11/13/2022] Open
Abstract
Anaphylaxis is the most severe form of allergic reaction, resulting from the effect of mediators and chemotactic substances released by activated cells. Mast cells and basophils are considered key players in IgE-mediated human anaphylaxis. Beyond IgE-mediated activation of mast cells/basophils, further mechanisms are involved in the occurrence of anaphylaxis. New insights into the potential relevance of pathways other than mast cell and basophil degranulation have been unraveled, such as the activation of the contact and the coagulation systems. Mast cell heparin released upon activation provides negatively charged surfaces for factor XII (FXII) binding and auto-activation. Activated FXII, the initiating serine protease in both the contact and the intrinsic coagulation system, activates factor XI and prekallikrein, respectively. FXII-mediated bradykinin (BK) formation has been proven in the human plasma of anaphylactic patients as well as in experimental models of anaphylaxis. Moreover, the severity of anaphylaxis is correlated with the increase in plasma heparin, BK formation and the intensity of contact system activation. FXII also activates plasminogen in the fibrinolysis system. Mast cell tryptase has been shown to participate in fibrinolysis through plasmin activation and by facilitating the degradation of fibrinogen. Some usual clinical manifestations in anaphylaxis, such as angioedema or hypotension, or other less common, such as metrorrhagia, may be explained by the direct effect of the activation of the coagulation and contact system driven by mast cell mediators.
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Affiliation(s)
- Mar Guilarte
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,VHIR Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Anna Sala-Cunill
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,VHIR Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Olga Luengo
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,VHIR Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Moisés Labrador-Horrillo
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,VHIR Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Victoria Cardona
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,VHIR Institut de Recerca Vall d'Hebron, Barcelona, Spain
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20
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Vikrant S, Parashar A. Acute kidney injury due to multiple Hymenoptera stings-a clinicopathological study. Clin Kidney J 2017; 10:532-538. [PMID: 29340149 PMCID: PMC5761506 DOI: 10.1093/ckj/sfx010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/20/2017] [Indexed: 11/14/2022] Open
Abstract
Background Acute kidney injury (AKI) after multiple Hymenoptera stings is well known but still a rare phenomenon. Methods We conducted a retrospective study of the clinicopathological spectrum of AKI due to multiple Hymenoptera stings over 13 years (July 2003-June 2016). Results A total of 35 patients were diagnosed with AKI due to multiple Hymenoptera stings. The mean age of the patients was 44.7 ± 17.4 years and the majority (60%) were men. Haematological and biochemical laboratory abnormalities included anaemia (97.1%), leucocytosis (54.3%), hyperkalaemia (68.6%), severe metabolic acidosis (51.4%), hepatic dysfunction (74.3%), haemolysis (91.4%) and rhabdomyolysis (62.9%). The main complications included acute respiratory distress syndrome (ARDS) and encephalopathy in four (11.4%) patients each; gastrointestinal bleeding, hypertension and panniculitis in two (5.7%) patients each and one (2.9%) patient each developed intra-abdominal bleeding, stroke and polyserositis. Twenty-nine (83%) patients required dialysis. Ten (29%) patients died. A higher white blood cell count (P = 0.05) and the complications of ARDS (P = 0.004) and encephalopathy (P = 0.004) were associated with mortality. The kidney functions normalized at 5.5 ± 2.6 weeks in patients who survived. Kidney biopsy was done in 13 patients. The predominant lesion was acute tubular necrosis (ATN) with or without pigmented granular cast in 10 (77%) patients. In four (30.8%) patients, the kidney biopsy showed severe ATN and in the other six (46.2%), the kidney biopsy showed features of ATN associated with mild to moderate acute interstitial nephritis (AIN). In three (23%) patients the histopathological examination revealed only moderate AIN and these patients were treated with a short course of steroids. Conclusions AKI due to multiple Hymenoptera stings is severe and is associated with high mortality. On renal histology, ATN and AIN are common.
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Affiliation(s)
- Sanjay Vikrant
- Department of Nephrology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anupam Parashar
- Community Medicine, Indira Gandhi Medial College, Shimla, Himachal Pradesh, India
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21
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Toletone A, Voltolini S, Passalacqua G, Dini G, Bignardi D, Minale P, Massa E, Signori A, Troise C, Durando P. Hymenoptera venom allergy in outdoor workers: Occupational exposure, clinical features and effects of allergen immunotherapy. Hum Vaccin Immunother 2017; 13:477-483. [PMID: 27924689 PMCID: PMC5328232 DOI: 10.1080/21645515.2017.1264748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/14/2016] [Accepted: 10/25/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To describe (i) the clinical characteristics of workers, exposed to hymenoptera stings, with an ascertained diagnosis of Hymenoptera Venom Allergy (HVA), (ii) the specific role of occupational exposure, (iii) the effect of Venom Immunotherapy (VIT) in reducing the severity of allergic episodes in workers exposed to repeated stings of hymenoptera, and (iv) the management of the occupational consequences caused by allergic reactions due to hymenoptera stings. METHODS Between 2000 and 2013 an observational study, including patients referred to the regional reference hospital of Liguria, Italy, with an ascertained diagnosis of HVA and treated with VIT, was performed. A structured questionnaire was administered to all patients to investigate the occupational features of allergic reactions. These were graded according to standard systems in patients at the first episode, and after re-stings, during VIT. RESULTS One-hundred and 8four out of the 202 patients referred had a complete data set. In 32 (17.4%) patients, the allergic reaction occurred during work activities performed outdoor. Of these, 31.2% previously stung by hymenoptera at work, and receiving VIT, were re-stung during occupational activity. The grades of reaction developed under VIT treatment resulted clinically less severe than of those occurred at the first sting (p-value = 0.031). CONCLUSION Our findings confirmed the clinical relevance of HVA, and described its occupational features in outdoor workers with sensitization, stressing the importance of an early identification and proper management of the professional categories recognized at high risk of hymenoptera stings. The Occupational Physician should be supported by other specialists to recommend appropriate diagnostic procedures and the prescription of VIT, which resulted an effective treatment for the prevention of episodes of severe reactions in workers with a proven HVA.
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Affiliation(s)
- Alessandra Toletone
- Department of Health Sciences, Postgraduate School in Occupational Medicine and Occupational Medicine Unit, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | | | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, Department of Internal Medicine, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences, Postgraduate School in Occupational Medicine and Occupational Medicine Unit, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | | | - Paola Minale
- Allergy Unit, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Emanuela Massa
- Department of Health Sciences, Postgraduate School in Occupational Medicine and Occupational Medicine Unit, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences, Biostatistics Unit, University of Genoa, Genoa, Italy
| | | | - Paolo Durando
- Department of Health Sciences, Postgraduate School in Occupational Medicine and Occupational Medicine Unit, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
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22
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Kim M, Kim W, Kim S. Exotropia in a pediatric patient with rhabdomyolysis caused by an insect sting. Indian J Ophthalmol 2017. [PMID: 28643726 PMCID: PMC5508472 DOI: 10.4103/ijo.ijo_600_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Various ocular and systemic reactions have been associated with insect sting. However, insect stings have been rarely reported to cause exotropia and diplopia. We encountered exotropia in a 6-year-old child with rhabdomyolysis of the left lower extremities caused by an insect sting. Exotropia and diplopia developed within 1 day after the sting and improved completely 1 week after the onset of symptoms. Clinicians should be aware of the potential for the development of exotropia in patients with insect stings, which requires careful follow-up.
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23
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Méndez GP, Enos D, Moreira JL, Alvaredo F, Oddó D. Nephrotic syndrome due to minimal change disease secondary to spider bite: clinico-pathological case of a non-described complication of latrodectism. Clin Kidney J 2016; 10:229-232. [PMID: 28396739 PMCID: PMC5381243 DOI: 10.1093/ckj/sfw110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 09/29/2016] [Indexed: 11/13/2022] Open
Abstract
The patient was an 18-year-old man who developed nephrotic syndrome after a 'wheat spider' bite (Latrodectus mactans). Due to this atypical manifestation of latrodectism, a renal biopsy was performed showing minimal change disease. The nephrotic syndrome subsided after 1 week without specific treatment. This self-limited evolution suggests that the mechanism of podocyte damage was temporary and potentially mediated by a secondary mechanism of hypersensitivity or direct effect of the α-latrotoxin. The patient did not show signs of relapse in subsequent checkup. This is the first reported case of nephrotic syndrome due to a minimal change lesion secondary to latrodectism.
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Affiliation(s)
- Gonzalo P Méndez
- Department of Pathology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, RM, Chile
| | - Daniel Enos
- Nephrology Unit, Clínica Los Andes, Los Angeles, Provincia de Bío Bío, VIII Región, Chile
| | - José Luis Moreira
- Nephrology Unit, Clínica Los Andes, Los Angeles, Provincia de Bío Bío, VIII Región, Chile
| | - Fátima Alvaredo
- Nephrology Unit, Hospital Universitario Río Hortega, Valladolid, Spain
| | - David Oddó
- Department of Pathology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, RM, Chile
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24
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Anticytoplasm neutrophil antibodies–positive vasculitis with diffuse alveolar hemorrhage related to a spider bite. Am J Emerg Med 2016; 34:339.e3-4. [DOI: 10.1016/j.ajem.2015.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/03/2015] [Indexed: 11/19/2022] Open
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In SH, Shin YC, Hwang EK, You HW, Kim JIL, Park JH, Jang AS. Unusual reaction to Hymenoptera stings. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.4.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Suk-Hwan In
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Young-Cheol Shin
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eui-Kwon Hwang
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hae-Won You
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jun-IL Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - June-Hyuck Park
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - An-Soo Jang
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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26
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Jimenez-Sanders R, Behrouz R, Tsakadze N. Allergic encephalitis with gelastic status epilepticus induced by wasp sting. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e114. [PMID: 26015991 PMCID: PMC4436594 DOI: 10.1212/nxi.0000000000000114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/25/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Rebecca Jimenez-Sanders
- Department of Neurology (R.J.-S., N.T.), University of South Florida Morsani College of Medicine, Tampa, FL; and Department of Neurology (R.B.), The Ohio State University College of Medicine, Columbus, OH
| | - Réza Behrouz
- Department of Neurology (R.J.-S., N.T.), University of South Florida Morsani College of Medicine, Tampa, FL; and Department of Neurology (R.B.), The Ohio State University College of Medicine, Columbus, OH
| | - Nina Tsakadze
- Department of Neurology (R.J.-S., N.T.), University of South Florida Morsani College of Medicine, Tampa, FL; and Department of Neurology (R.B.), The Ohio State University College of Medicine, Columbus, OH
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Niyaz L, Gul A, Gungor I, Duran M. Paralytic strabismus and papilloedema caused by dural sinus thrombosis after bee sting. Trop Doct 2014; 45:44-5. [PMID: 25234425 DOI: 10.1177/0049475514550062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A patient that developed paresis of the sixth cranial nerve and bilateral papilloedema after the bee sting to the periocular area is presented. Magnetic resonance venography showed a unilateral transverse and sigmoid sinus thrombosis. The patient was successfully treated with anticoagulation and intracranial pressure lowering treatment.
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Affiliation(s)
- Leyla Niyaz
- Assistant Professor, Department of Ophthalmology, Ondokuz Mayis University Hospital, Samsun, Turkey
| | - Adem Gul
- Assistant Professor, Department of Ophthalmology, Ondokuz Mayis University Hospital, Samsun, Turkey
| | - Inci Gungor
- Associate Professor, Department of Ophthalmology, Ondokuz Mayis University Hospital, Samsun, Turkey
| | - Mustafa Duran
- Resident, Department of Ophthalmology, Ondokuz Mayis University Hospital, Samsun, Turkey
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30
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Isawumi MA, Hassan MB. Honeybee sting of the sclera: occular features, treatment, outcome and presumed pathogenesis. Pan Afr Med J 2014; 17:30. [PMID: 24932341 PMCID: PMC4048680 DOI: 10.11604/pamj.2014.17.30.3297] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 11/22/2013] [Indexed: 11/18/2022] Open
Abstract
Ocular bee sting injury has caused several reactions in the eye but has rarely been reported among local African farmers, and Nigerians in particular. This case seeks to report the first ocular and external eye reactions following a honey bee sting of the eye through the sclera, highlighting the treatment and outcome. Oral interview, clinical examination and external photographs were used to obtain and document findings. Medical treatment was instituted as soon as subject presented. There was complete inflammatory resolution within a week, normal vision and no evidence of stinger migration after four weeks of follow up. The wound site healed with ciliary staphyloma. The role of physical properties, immunological and genetics interplay and the presumed pathogenesis is further discussed. Health education on early presentation and avoidance of harmful traditional eye medications should be promoted among the farming populations in our communities, in order to prevent blinding complications
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Hemichorea after multiple bee stings. Am J Emerg Med 2013; 32:196.e1-2. [PMID: 24268878 DOI: 10.1016/j.ajem.2013.09.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 09/23/2013] [Indexed: 11/20/2022] Open
Abstract
Bee sting is one of the most commonly encountered insect bites in the world. Despite the common occurrence of local and systemic allergic reactions, there are few reports of ischemic stroke after bee stings. To the best our knowledge, there have been no reports on involuntary hyperkinetic movement disorders after multiple bee stings. We report the case of a 50-year-old man who developed involuntary movements of the left leg 24 hours after multiple bee stings, and the cause was confirmed to be a right temporal infarction on a diffusion magnetic resonance imaging scan. Thus, we concluded that the involuntary movement disorder was caused by right temporal infarction that occurred after multiple bee stings.
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32
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Nestorovic B, Milosevic K, Rsovac S, Nikolic A. Anaphylaxis followed by unilateral lung opacity and hypocomplementemia in a young female. Am J Emerg Med 2013; 31:1623.e1-2. [PMID: 23896012 DOI: 10.1016/j.ajem.2013.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 06/07/2013] [Accepted: 06/17/2013] [Indexed: 11/18/2022] Open
Abstract
A 36-year-old woman was stung in the right wrist by a bee, suffered typical anaphylaxis, and was transferred to a local hospital. After a few hours, which corresponded to late-onset reaction, she developed shortness of breath and weakness and was transferred to the emergency department, where the diagnosis of anaphylaxis was confirmed. Serum complement levels, components C3 and C4, were undetectable. Flexible bronchoscopy excluded lung hemorrhage. She was on the ventilator for 4 days and was fully awake during that time. After the treatment, her improvement was rapid, and she fully recovered. Three weeks after she had been stung by a bee, skin prick tests to bee, wasp, and yellow jacket venom were done, and all tests came back negative as well as IgE and IgG4 antibodies to the same venoms. Coagulation factors and the complement, including C1q inhibitor, were normal. Occurrence of complement activation and consumption could point to the immune complexes as basis of pathophysiological mechanism. It remains unclear why such a reaction would involve only the right lung and why no detectable immune complexes were discovered. The clinical picture in the presented case resembled acute respiratory distress syndrome, but the exact nature of lung consolidation remains puzzling. The most likely explanation is a very rare case of airway obstruction. To our knowledge, this is the only reported case of anaphylaxis associated with undetectable serum complement levels. The potential role and diagnostic significance of hypocomplementemia in cases of anaphylaxis should be further investigated.
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34
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Cochran J, McSwain SD, Evans M, Webb S, Tecklenburg F. Anaphylaxis and delayed hymenoptera in a child with fire ant envenomation. Am J Emerg Med 2013; 31:632.e1-3. [PMID: 23347720 DOI: 10.1016/j.ajem.2012.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 09/18/2012] [Indexed: 11/28/2022] Open
Affiliation(s)
- Joel Cochran
- Division of Pediatric Critical Care Department of Pediatrics Medical University of South Carolina Charleston, SC, USA.
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35
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Allergic reactions to stinging and biting insects. Clin Immunol 2013. [DOI: 10.1016/b978-0-7234-3691-1.00056-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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36
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Volders J, Smits M, Folkersma G, Tjan DH. An unusual neurological consequence of massive wasp stings. BMJ Case Rep 2012; 2012:bcr.01.2012.5555. [PMID: 22744238 DOI: 10.1136/bcr.01.2012.5555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Although rare, central and peripheral neurological manifestations after single or multiple wasp stings have been reported. The authors describe a 45-year-old man who developed periods of sudden loss of consciousness with a Glasgow Coma Scale of 6 after being stung by fifty wasps. These periods were seen directly after being stung and were continuing months later. Different mechanisms and pathophysiological findings of neurological sequela reported after wasp stings are being reviewed.
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Affiliation(s)
- José Volders
- Intensive Care, Gelderse Vallei Hospital, Ede, Netherlands.
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Ventriculoperitoneal shunt infection after an insect sting. Childs Nerv Syst 2012; 28:955-7. [PMID: 22322456 DOI: 10.1007/s00381-012-1700-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 01/11/2012] [Indexed: 10/14/2022]
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Dechyapirom W, Cevik C, Nugent K. Concurrent acute coronary syndrome and ischemic stroke following multiple bee stings. Int J Cardiol 2011; 151:e47-52. [PMID: 20488565 DOI: 10.1016/j.ijcard.2010.04.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 04/21/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022]
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40
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Viswanathan S, Prabhu C, Arulneyam J, Remalayam B, Adil M. Yellow jacket envenomation-related acute renal failure. Clin Kidney J 2011; 4:167-9. [PMID: 25984147 PMCID: PMC4421610 DOI: 10.1093/ndtplus/sfr020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 02/09/2011] [Indexed: 11/16/2022] Open
Abstract
We report a 58-year-old man with multiple yellow jacket stings who developed urticaria, renal failure, quadriparesis, rhabdomyolysis in succession. Investigations revealed renal and hepatic dysfunction, proteinuria, demyelinating polyradiculoneuropathy, acute tubular necrosis and glomerulonephritis. He improved with methylprednisolone, antihypertensives and two sessions of haemodialysis.
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Affiliation(s)
- Stalin Viswanathan
- Department of Internal Medicine, Pondicherry Institute of Medical Sciences, Kalapet, Pondicherry, South India
| | - Chaitanya Prabhu
- Department of Nephrology, Pondicherry Institute of Medical Sciences, Kalapet, Pondicherry, South India
| | - Jayanthi Arulneyam
- Department of Neurology, Pondicherry Institute of Medical Sciences, Kalapet, Pondicherry
| | - Bhavith Remalayam
- Department of Internal Medicine, Pondicherry Institute of Medical Sciences, Kalapet, Pondicherry, South India
| | - Mohammed Adil
- Department of Internal Medicine, Pondicherry Institute of Medical Sciences, Kalapet, Pondicherry, South India
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Lee YS, Kim MS, Kim US, Yu SY, Kwak HW. Unilateral Papillitis after Bee Stings on the Hand. Neuroophthalmology 2011. [DOI: 10.3109/01658107.2011.580897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Myocardial infarction in a 45-year-old man following an anaphylactic reaction to a wasp sting. Int J Cardiol 2011; 148:e63-5. [DOI: 10.1016/j.ijcard.2009.03.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 03/03/2009] [Indexed: 11/18/2022]
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43
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Moss P, Beeching NJ. Arthropods and ectoparasites. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Alemán Navas RM, Martínez Mendoza MG, Herrera H, Herrera HPD. Floor of the nose mucosa lysis and labial abscess caused by a bee sting. Braz Dent J 2009; 20:249-53. [PMID: 19784473 DOI: 10.1590/s0103-64402009000300014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hymenoptera order includes bees, which have a stinging apparatus at the tail capable of delivering venom to the affected tissues. Myocardial infarction, acute renal failure, Necrotizing fasciitis, fatal infection and hemifacial asymmetry, are some of the unusual reactions reported following hymenoptera stings. This paper reports a case of bee sting in the right floor of the nose that mimicked an odontogenic infection affecting the upper lip, canine space and nasal cavity such as in cases of infection secondary to pulpal or periodontal pathology of the anterior teeth. After a thorough clinical and radiographic examination, odontogenic infection was discarded and the diagnosis of floor of the nose mucosal lysis and lip abscess secondary to a bee sting was made. This case was successfully managed with adequate incision, drainage and antibiotics without any further complication. There are several reports of unusual reactions following hymenoptera stings. However, just a few of them referred to infections of local reactions and none of them related to the anatomic location affected in the patient of the present case. Early diagnosis and treatment prevented infection dissemination and the likelihood of tissue necrosis as in previously reported cases of Necrotizing fasciitis.
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Affiliation(s)
- Ramón Manuel Alemán Navas
- Department of Oral and Maxillofacial Surgery, Zacamil's Nacional Hospital, Evangelic University of El Salvador, San Salvador, El Salvador.
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Bacchetta J, Dubourg L, Juillard L, Cochat P. Non-drug-induced nephrotoxicity. Pediatr Nephrol 2009; 24:2291-300. [PMID: 19399523 DOI: 10.1007/s00467-009-1180-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Revised: 03/16/2009] [Accepted: 03/17/2009] [Indexed: 12/29/2022]
Abstract
Several drugs and other compounds can induce acute and/or chronic nephrotoxicity. The goal of this study was to review clinical features of nephrotoxicity induced by 'atypical' or 'unconventional' agents, such as environmental agents (metals, minerals, animals), food agents (mushrooms, aristolochic acid, medicinal traditional herbals, dietary supplements, melamine), drugs, and other products (ethylene glycol). Nephrotoxicity varies according to local background, dependent on different food and cultural customs, as well as to differences in local fauna and flora. The incidence of such a phenomenon is not well known. Many different pathophysiological pathways are involved, and the spectrum of renal lesions is rather wide. 'Epidemic nephrotoxicity' may occur, as recently illustrated by the melamine epidemics in Chinese infants receiving powdered milk formulas; a rapid reaction to unusual increased frequency of acute kidney injury and nephrolithiasis in young children has led to a rapid analysis from international experts, with subsequent recommendations for diagnosis and care. Nephrotoxicity should be considered when there is any unexplained renal impairment, especially in children.
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Affiliation(s)
- Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie et Rhumatologie Pédiatriques, Hôpital Femme Mère Enfant, Boulevard Pinel, 69677 Bron, France
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Acute stent thrombosis in a sirolimus eluting stent after wasp sting causing acute myocardial infarction: a case report. CASES JOURNAL 2009; 2:7800. [PMID: 19918484 PMCID: PMC2769374 DOI: 10.4076/1757-1626-2-7800] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 07/27/2009] [Indexed: 12/18/2022]
Abstract
Introduction Hymenoptera venoms contain thrombogenic substances that might be responsible for cardiovascular events independent of anaphylactic reactions. Case presentation We report a 55-year-old man who experienced an acute ST-elevation myocardial infarction after wasp sting. The patient presented without signs of anaphylaxis or shock. The coronary angiography showed an acute stent thrombosis of the right coronary artery. Percutanous coronary intervention was performed immediately and this is an example for a cardiovascular complication associated with a hymenoptera sting, since the vasoactive, inflammatory, and thrombogenic substances of hymenoptera venoms potentially cause stent thrombosis and myocardial ischemia. To the best of our knowledge this is the first report of acute stent thrombosis in a sirolimus-eluting stent following hymenoptera sting. Conclusion Stent thrombosis is a possible complication after wasp sting induced by thrombogenic substances of the hymenoptera venom.
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Quercia O, Emiliani F, Foschi FG, Stefanini GF. Ventricular fibrillation after a hymenoptera sting. Int J Cardiol 2008; 127:e5-7. [PMID: 17442421 DOI: 10.1016/j.ijcard.2007.01.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 01/01/2007] [Indexed: 10/23/2022]
Abstract
A 54-year-old male, who had presented 2 ventricular fibrillation (VF) episodes with post-anoxic coma and later a return to consciousness and to a sinusal rhythm after defibrillation, have been placed a ventricular intracavitary stimulator (AICD). Since all the tests including the coronarygraphy have been found normal, we have paid attention to the anamnesis revealing an Apis mellifera sting before both VF episodes, previously considered irrelevant for the absence of relevant local symptoms. Intracutaneous tests were negative to Vespula sp. and positive to A. mellifera extract at a concentration of 0.01 mug/ml. Specific IgE for A. mellifera venom presented values of 2,36 U/ml for A. mellifera and <0.35 U/ml per Vespula sp. and Polistes dominulus. The patient was then submitted to ITS with A. mellifera aqueous extract. During the RASH treatment no adverse reactions have been observed, whereas we witnessed a major adverse reaction, 3 min after the first 100 mcg maintenance dose, controlled with anti-H1 and cortisone reaction, nevertheless no reactions were observed during the 3 years the same dosage has been repeated monthly. Our case supports the hypothesis of an anaphylactic reaction as trigger of vasoconstriction in individuals affected by ventricular arrhythmia not explained with other causes such as a coronary disease, a myocardiopathy or a pharmacological toxicity. Arrhythmia can be a serious outbreak of a mediated IgE allergic reaction even without any relevant local symptoms. The diagnostics with lyophilized A. mellifera venom has been proven safe in a patient who suffered a cardiac anaphylaxis.
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48
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Allergic reactions to stinging and biting insects. Clin Immunol 2008. [DOI: 10.1016/b978-0-323-04404-2.10043-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Abstract
We describe a 59-year-old patient who developed acute renal failure because of rhabdomyolysis after extensive red fire ant bites. This case illustrates a serious systemic reaction that may occur from fire ant bites. Consistent with the clinical presentation in rhabdomyolysis associated with non-traumatic causes, hyperkalemia, hypophosphatemia, hypocalcemia, and high anion gap acidosis were not observed in this patient. While local allergic reactions to fire ant bites are described in the literature, serious systemic complications with rhabdomyolysis and renal failure have not been previously reported. It is our effort to alert the medical community of the possibility of such a complication that can occur in the victims of fire ant bites.
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Affiliation(s)
- Supriya Koya
- Internal Medicine Residency Program, University of Alabama at Birmingham, Montgomery, AL 36116 USA
- UAB Internal medicine residency program, 4371 Narrow lane road, Suite 200, Montgomery, AL 36116 USA
| | - Daryl Crenshaw
- Internal Medicine Residency Program, University of Alabama at Birmingham, Montgomery, AL 36116 USA
| | - Anupam Agarwal
- Division of Nephrology, ZRB 614, University of Alabama at Birmingham, 1530 3rd Avenue South, Birmingham, AL 35294 USA
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