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Abstract
Red meat allergies have followed tick bites on every continent except Antarctica. The sensitizing antigen is galactose-α-1,3-galactose (α-gal), an oligosaccharide constituent of nonprimate blood and meat, acquired by ticks during animal bloodfeeding. Because red meat allergy after tick bites is a worldwide phenomenon, the objectives of this review were to describe the global epidemiology of red meat allergy after tick bites and its immunological mechanisms; to identify the human risk factors for red meat allergy after tick bites; to identify the most common tick vectors of red meat allergy worldwide; to describe the clinical manifestations, diagnostic confirmation, and management of patients with red meat allergy after tick bites; and to recommend strategies for the prevention of tick bites. To meet these objectives, Internet search engines were queried with keywords to select scientific articles for review. The keywords included ticks, tick bites, allergy, anaphylaxis, and meat allergy. The study period was defined as 1980-2019. The major risk factors for red meat allergy after tick bites included male sex, non-B blood type, systemic mastocytosis, a bioprosthetic (bovine or porcine) heart valve, and preexisting allergies to gelatin or animal dander. Following confirmation by challenge testing, patients with red meat allergies should avoid red meats, foods containing gelatin, and intravenous immunotherapy with monoclonal antibodies such as cetuximab and infliximab produced in SP2/0 mouse cell lines. Red meat allergy after tick bites represents an emerging threat from tick bites in addition to infectious diseases.
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Affiliation(s)
- James H Diaz
- From the School of Public Health, Environmental, and Occupational Health Sciences, Louisiana State University Health Sciences Center, New Orleans
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2
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van Nunen SA. Tick-induced allergies: mammalian meat allergy and tick anaphylaxis. Med J Aust 2019; 208:316-321. [PMID: 29642819 DOI: 10.5694/mja17.00591] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/27/2017] [Indexed: 01/01/2023]
Abstract
Mammalian meat allergy after tick bites and tick anaphylaxis are the most serious tick-induced allergies. They are often severe, should be largely avoidable and offer fascinating insights into the development and prevention of allergies. Australian clinicians reported the first cases of tick anaphylaxis and discovered the association between tick bites and the development of mammalian meat allergy. The subsequent finding of the allergen epitope within the meat responsible for the allergic reaction, α-gal (galactose-α-1,3-galactose), stimulated further interest in this emergent allergy. Reports of mammalian meat allergy associated with bites from several tick species have now come from every continent where humans are bitten by ticks. The number of diagnosed patients has continued to rise. Clinically, mammalian meat allergy and tick anaphylaxis present quite differently. The prominent role of cofactors in triggering episodes of mammalian meat allergy can make its diagnosis difficult. Management of mammalian meat allergy is complicated by the manifold potential therapeutic implications due to the widespread distribution of the mammalian meat allergen, α-gal. Exposures to α-gal-containing medications have proved lethal in a minority of people, and fatal tick anaphylaxis has been reported in Australia. Prevention of tick bites is prudent and practicable; killing the tick in situ is crucial to both primary and secondary prevention of allergic reactions. Mechanisms in the development of mammalian meat allergy constitute a paradigm for how allergies might arise.
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Galactose α-1,3-galactose phenotypes: Lessons from various patient populations. Ann Allergy Asthma Immunol 2019; 122:598-602. [PMID: 30922956 DOI: 10.1016/j.anai.2019.03.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/13/2019] [Accepted: 03/15/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To review published studies on galactose α-1,3-galactose (α-gal), a carbohydrate epitope found on proteins and lipids in nonprimate mammals and present in foods (particularly organ or fat-rich red meat) and medications, where it causes delayed-onset and immediate-onset anaphylaxis. DATA SOURCES A literature search for the terms galactose α-1,3-galactose and α-gal using PubMed and Embase was performed. STUDY SELECTIONS Studies on α-gal were included in this review. RESULTS Several species of ticks contain α-gal epitopes and possibly salivary adjuvants that promote high titer sensitization and clinical reactivity. Risk factors for α-gal syndrome include exposure to ticks of particular species. Age and sex differences seen in various cohorts possibly reflect the prevalence of these exposures that vary according to setting. CONCLUSION The reason and mechanisms for delayed onset of food-related anaphylaxis and the preponderance of abdominal reactions are not clear but may involve the kinetics of allergen digestion and processing or immunologic presentation via a different mechanism from usual immediate-type food allergy.
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Abstract
Insect bites and stings are common. Risk factors are mostly associated with environmental exposure. Most insect bites and stings result in mild, local, allergic reactions. Large local reactions and systemic reactions like anaphylaxis are possible. Common insects that bite or sting include mosquitoes, ticks, flies, fleas, biting midges, bees, and wasps. The diagnosis is made clinically. Identification of the insect should occur when possible. Management is usually supportive. For anaphylaxis, patients should be given epinephrine and transported to the emergency department for further evaluation. Venom immunotherapy (VIT) has several different protocols. VIT is highly effective in reducing systemic reactions and anaphylaxis.
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Affiliation(s)
- Hobart Lee
- Department of Family Medicine, Loma Linda University, 25455 Barton Road, Suite 209B, Loma Linda, CA 92354, USA.
| | - Sara Halverson
- Department of Family Medicine, Loma Linda University, 25455 Barton Road, Suite 209B, Loma Linda, CA 92354, USA
| | - Regina Mackey
- Department of Family Medicine, Loma Linda University, 25455 Barton Road, Suite 209B, Loma Linda, CA 92354, USA
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Chalada MJ, Stenos J, Bradbury RS. Is there a Lyme-like disease in Australia? Summary of the findings to date. One Health 2016; 2:42-54. [PMID: 28616477 PMCID: PMC5441348 DOI: 10.1016/j.onehlt.2016.03.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 03/19/2016] [Accepted: 03/19/2016] [Indexed: 01/06/2023] Open
Abstract
Lyme Borreliosis is a common tick-borne disease of the northern hemisphere caused by the spirochaetes of the Borrelia burgdorferi sensu lato (B. burgdorferi s. l.) complex. It results in multi-organ disease with arthritic, cardiac, neurological and dermatological manifestations. In the last twenty-five years there have been over 500 reports of an Australian Lyme-like syndrome in the scientific literature. However, the diagnoses of Lyme Borreliosis made in these cases have been primarily by clinical presentation and laboratory results of tentative reliability and the true cause of these illnesses remains unknown. A number of animals have been introduced to Australia that may act as B. burgdorferi s. l. reservoirs in Lyme-endemic countries, and there are some Australian Ixodes spp. and Haemaphysalis spp. ticks whose geographical distribution matches that of the Australian Lyme-like cases. Four published studies have searched for Borrelia in Australian ticks, with contradicting results. The cause of the potential Lyme-like disease in Australia remains to be defined. The evidence to date as to whether these illnesses are caused by a Borrelia species, another tick borne pathogen or are due to a novel or unrelated aetiology is summarised in this review.
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Affiliation(s)
- Melissa Judith Chalada
- School of Medical & Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - John Stenos
- Australian Rickettsial Reference Laboratory, Barwon Health, Geelong, Victoria, Australia
| | - Richard Stewart Bradbury
- School of Medical & Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
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Fernández-Soto P, Dávila I, Laffond E, Lorente F, Encinas-Grandes A, Pérez-Sánchez R. Tick-bite-induced anaphylaxis in Spain. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2016. [DOI: 10.1080/00034983.2001.11813619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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7
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Abstract
Hypersensitivity in the allergic setting refers to immune reactions, stimulated by soluble antigens that can be rapidly progressing and, in the case of anaphylaxis, are occasionally fatal. As the number of known exposures associated with anaphylaxis is limited, identification of novel causative agents is important in facilitating both education and other allergen-specific approaches that are crucial to long-term risk management. Within the last 10 years, several seemingly separate observations were recognized to be related, all of which resulted from the development of antibodies to a carbohydrate moiety on proteins where exposure differed from airborne allergens but which were nevertheless capable of producing anaphylactic and hypersensitivity reactions. Our recent work has identified these responses as being due to a novel IgE antibody directed against a mammalian oligosaccharide epitope, galactose-alpha-1,3-galactose (alpha-gal). This review will present the history and biology of alpha-gal and discuss our current approach to management of the mammalian meat allergy and delayed anaphylaxis.
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van Nunen S. Tick-induced allergies: mammalian meat allergy, tick anaphylaxis and their significance. Asia Pac Allergy 2015; 5:3-16. [PMID: 25653915 PMCID: PMC4313755 DOI: 10.5415/apallergy.2015.5.1.3] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 12/21/2022] Open
Abstract
Serious tick-induced allergies comprise mammalian meat allergy following tick bites and tick anaphylaxis. Mammalian meat allergy is an emergent allergy, increasingly prevalent in tick-endemic areas of Australia and the United States, occurring worldwide where ticks are endemic. Sensitisation to galactose-α-1,3-galactose (α-Gal) has been shown to be the mechanism of allergic reaction in mammalian meat allergy following tick bite. Whilst other carbohydrate allergens have been identified, this allergen is unique amongst carbohydrate food allergens in provoking anaphylaxis. Treatment of mammalian meat anaphylaxis involves avoidance of mammalian meat and mammalian derived products in those who also react to gelatine and mammalian milks. Before initiating treatment with certain therapeutic agents (e.g., cetuximab, gelatine-containing substances), a careful assessment of the risk of anaphylaxis, including serological analysis for α-Gal specific-IgE, should be undertaken in any individual who works, lives, volunteers or recreates in a tick endemic area. Prevention of tick bites may ameliorate mammalian meat allergy. Tick anaphylaxis is rare in countries other than Australia. Tick anaphylaxis is secondarily preventable by prevention and appropriate management of tick bites. Analysis of tick removal techniques in tick anaphylaxis sufferers offers insights into primary prevention of both tick and mammalian meat anaphylaxis. Recognition of the association between mammalian meat allergy and tick bites has established a novel cause and effect relationship between an environmental exposure and subsequent development of a food allergy, directing us towards examining environmental exposures as provoking factors pivotal to the development of other food allergies and refocusing our attention upon causation of allergy in general.
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Affiliation(s)
- Sheryl van Nunen
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital and Sydney Medical School-Northern, St Leonards NSW 2065, Australia
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Oltean BM, Ernst M, Renneker S, Bakheit MA, Seitzer U, Ahmed J. Whole antigenic lysates of Ixodes ricinus, but not Der-p2 allergen-like protein, are potent inducers of basophil activation in previously tick-exposed human hosts. Transbound Emerg Dis 2014; 60 Suppl 2:162-71. [PMID: 24589117 DOI: 10.1111/tbed.12151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Indexed: 11/29/2022]
Abstract
The clinical suspicion of tick anaphylaxis is based on a history of the bite and occurs often during the warm season. Further arguments are the presence of natural hosts in the immediate environment and, eventually, the identification of the tick. The diagnosis is confirmed when immediate-type sensitization is shown by positive skin prick tests performed with specific tick extracts or the demonstration of specific IgE in vitro. In the current study, we hypothesize that hard tick-derived material contains potent inducers being able to promote basophil stimulation, which correlates with a sensitization immunological response following tick bites. To this end, biological material from two hard tick cell lines (IRE11 and IDE8 - derived from Ixodes ricinus and I. scapularis, respectively) as well as I. ricinus salivary gland and body lysates were used in a human basophil activation test (BAT) to analyse binding and cross-linking capacity of membrane-bound IgE, because basophils are one of the main effector cells of allergic reactions. Additionally, Der-p2 allergen-like gene from I. ricinus was recombinantly expressed as a 15-kDa histidine-tagged fusion protein, purified and included as a stimulus within the setup. Blood was drawn and submitted to BAT screening from a pool of 36 individuals, both bitten and who served solely as negative controls. We have found that seven subjects (19%), all of whom were at least two times tick-bitten, positively reacted to the aforementioned stimuli, whereas the reactivity level of the ones bearing single bites proved to be within the normal range. Moreover, no significant upregulation of the assessed basophil activation marker was detected in the case of Der-p2, except a faint reaction at high dosages. We conclude that at least two tick bites of the human host must occur in order to induce significant basophil activation.
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Affiliation(s)
- B M Oltean
- Research Center Borstel, Division of Veterinary Infection Biology and Immunology, Borstel, Germany
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Abdad MY, Cook A, Dyer J, Stenos J, Fenwick SG. Seroepidemiological study of outdoor recreationists' exposure to spotted fever group Rickettsia in Western Australia. Am J Trop Med Hyg 2014; 91:584-8. [PMID: 24935947 DOI: 10.4269/ajtmh.14-0102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Bushland activity has previously been linked to rickettsial exposure in eastern and central regions of Australia, whereas little is known about the risks in Western Australia. The isolation of Rickettsia gravesii sp. nov. from Amblyomma triguttatum ticks and anecdotal reports of low-grade illness among bush recreationists raised the possibility of rickettsial transmission in the State. This study investigated rickettsial seroprevalence and potential risk of exposure to the spotted fever group rickettsiae in rogainers. Our results showed that rogainers active in the bush had a significantly higher risk of seropositivity (immunofluorescence total antibody titer ≥ 128) for the spotted fever group Rickettsia (odds ratio [OR] = 14.02, 95% confidence interval [CI] = 1.38-142.07) compared with a reference population, the overall seroprevalence in the rogainer group being 23.1%.
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Affiliation(s)
- Mohammad Y Abdad
- Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia; School of Population Health, University of Western Australia, Perth, Western Australia, Australia; Fremantle Hospital, Fremantle, Western Australia, Australia; School of Veterinary and Biomedical Science, Murdoch University, Murdoch, Western Australia, Australia
| | - Angus Cook
- Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia; School of Population Health, University of Western Australia, Perth, Western Australia, Australia; Fremantle Hospital, Fremantle, Western Australia, Australia; School of Veterinary and Biomedical Science, Murdoch University, Murdoch, Western Australia, Australia
| | - John Dyer
- Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia; School of Population Health, University of Western Australia, Perth, Western Australia, Australia; Fremantle Hospital, Fremantle, Western Australia, Australia; School of Veterinary and Biomedical Science, Murdoch University, Murdoch, Western Australia, Australia
| | - John Stenos
- Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia; School of Population Health, University of Western Australia, Perth, Western Australia, Australia; Fremantle Hospital, Fremantle, Western Australia, Australia; School of Veterinary and Biomedical Science, Murdoch University, Murdoch, Western Australia, Australia
| | - Stanley G Fenwick
- Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia; School of Population Health, University of Western Australia, Perth, Western Australia, Australia; Fremantle Hospital, Fremantle, Western Australia, Australia; School of Veterinary and Biomedical Science, Murdoch University, Murdoch, Western Australia, Australia
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11
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Rappo TB, Cottee AM, Ratchford AM, Burns BJ. Tick bite anaphylaxis: incidence and management in an Australian emergency department. Emerg Med Australas 2013; 25:297-301. [PMID: 23911019 DOI: 10.1111/1742-6723.12093] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Ticks are endemic to the eastern coastline of Australia. The aim of the present study is to describe the incidence of tick bites in such an area, the seasonal and geographical distribution, the incidence of anaphylaxis due to tick bite and its management. METHODS We retrospectively analysed emergency presentations of patients with tick bites to Mona Vale Hospital on Sydney's Northern Beaches over a 2 year period from 1 January 2007 to 1 January 2009. We recorded the geographical and seasonal distribution of tick bites as well as the symptoms from tick bite and its emergency management. RESULTS We report over 500 cases of tick bites presenting to a single New South Wales hospital over a 2 year period, of which 34 resulted in anaphylaxis. Cutaneous symptoms were the most common feature associated with anaphylaxis (32/34, 94%). Forty per cent (13/34) of patients with tick bite anaphylaxis had a history of allergy or previous anaphylaxis. Seventy-six per cent (26/34) of patients were administered adrenaline either prior to presenting or in the ED, while 97% (33/34) were treated with steroids. Fifty-three per cent were referred to an immunologist and only one-quarter were discharged with an adrenaline auto-injector. CONCLUSION We report 34 cases of tick bite anaphylaxis over a 2 year period at a single hospital in a tick endemic area. The variation in the presenting symptoms and signs, as well as in management highlights the need for increased awareness for tick bite management in tick endemic areas.
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Affiliation(s)
- Tristan B Rappo
- Surgery, Hornsby Hospital, Sydney, New South Wales, Australia.
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12
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Commins SP, James HR, Kelly LA, Pochan SL, Workman LJ, Perzanowski MS, Kocan KM, Fahy JV, Nganga LW, Ronmark E, Cooper PJ, Platts-Mills TAE. The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1,3-galactose. J Allergy Clin Immunol 2011; 127:1286-93.e6. [PMID: 21453959 DOI: 10.1016/j.jaci.2011.02.019] [Citation(s) in RCA: 392] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 01/21/2011] [Accepted: 02/04/2011] [Indexed: 01/11/2023]
Abstract
BACKGROUND In 2009, we reported a novel form of delayed anaphylaxis to red meat that is related to serum IgE antibodies to the oligosaccharide galactose-α-1,3-galactose (alpha-gal). Most of these patients had tolerated meat for many years previously. The implication is that some exposure in adult life had stimulated the production of these IgE antibodies. OBJECTIVES We sought to investigate possible causes of this IgE antibody response, focusing on evidence related to tick bites, which are common in the region where these reactions occur. METHODS Serum assays were carried out with biotinylated proteins and extracts bound to a streptavidin ImmunoCAP. RESULTS Prospective studies on IgE antibodies in 3 subjects after tick bites showed an increase in levels of IgE to alpha-gal of 20-fold or greater. Other evidence included (1) a strong correlation between histories of tick bites and levels of IgE to alpha-gal (χ(2) = 26.8, P < .001), (2) evidence that these IgE antibodies are common in areas where the tick Amblyomma americanum is common, and (3) a significant correlation between IgE antibodies to alpha-gal and IgE antibodies to proteins derived from A americanum (r(s) = 0.75, P < .001). CONCLUSION The results presented here provide evidence that tick bites are a cause, possibly the only cause, of IgE specific for alpha-gal in this area of the United States. Both the number of subjects becoming sensitized and the titer of IgE antibodies to alpha-gal are striking. Here we report the first example of a response to an ectoparasite giving rise to an important form of food allergy.
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Affiliation(s)
- Scott P Commins
- Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville, VA, USA
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13
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Commins SP, Platts-Mills TAE. Anaphylaxis syndromes related to a new mammalian cross-reactive carbohydrate determinant. J Allergy Clin Immunol 2009; 124:652-7. [PMID: 19815111 DOI: 10.1016/j.jaci.2009.08.026] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 08/13/2009] [Accepted: 08/18/2009] [Indexed: 01/05/2023]
Abstract
Anaphylaxis is a severe allergic reaction that can rapidly progress and occasionally be fatal. In instances in which the triggering allergen is not obvious, establishing the cause of anaphylaxis is pivotal to long-term management. Assigning cause is limited, however, by the number of known exposures associated with anaphylaxis. Therefore identification of novel causative agents can provide an important step forward in facilitating new, allergen-specific approaches to management. In contrast to the view that carbohydrate-directed IgE has minimal, if any, clinical significance, recent data suggest that IgE antibodies to carbohydrate epitopes can be an important factor in anaphylaxis that might otherwise appear to be idiopathic. Here we review the evidence relating to carbohydrates in food allergy and anaphylaxis and discuss the implications of a new mammalian cross-reactive carbohydrate determinant.
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Affiliation(s)
- Scott P Commins
- Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville, USA.
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14
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Dana AN. Diagnosis and treatment of tick infestation and tick-borne diseases with cutaneous manifestations. Dermatol Ther 2009; 22:293-326. [PMID: 19580576 DOI: 10.1111/j.1529-8019.2009.01244.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hard and soft ticks may be associated directly or indirectly with a number of dermatoses, both infectious and inflammatory in origin. Morbidity may occur as a result of tick bites, tick toxicosis, and even infestation. These arthropod vectors may transmit life-threatening protozoan, bacterial, rickettsial, and viral diseases with systemic and cutaneous findings. Additionally, ticks may transmit more than one pathogen with subsequent human coinfection. This article reviews the presentation of tick-borne illnesses and the medical management of these diseases. Among others, diseases such as ehrlichiosis, anaplasmosis, babesiosis, tularemia, borrelioses, tick-borne encephalitides, rickettsial spotted fevers, and tick typhus are discussed in this article. The recognition of skin manifestations associated with these diseases is paramount to early diagnosis and treatment initiation.
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Affiliation(s)
- Ali N Dana
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland, USA.
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15
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Van Nunen SA, O'Connor KS, Clarke LR, Boyle RX, Fernando SL. An association between tick bite reactions and red meat allergy in humans. Med J Aust 2009; 190:510-1. [PMID: 19413526 DOI: 10.5694/j.1326-5377.2009.tb02533.x] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 02/16/2009] [Indexed: 11/17/2022]
Abstract
Twenty-five patients living in a tick-endemic region of Sydney, New South Wales developed red meat allergy after experiencing large local reactions to tick bites. This represents a potentially novel cross-reaction between an arthropod and a food protein. (MJA 2009; 190: 510-511).
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Klotz JH, Klotz SA, Pinnas JL. Animal bites and stings with anaphylactic potential. J Emerg Med 2007; 36:148-56. [PMID: 17997071 DOI: 10.1016/j.jemermed.2007.06.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Revised: 12/06/2006] [Accepted: 02/11/2007] [Indexed: 11/26/2022]
Abstract
Anaphylaxis to animal bites and stings poses a significant medical risk of vascular or respiratory reactions that vary according to the patient's response and nature of the insult. Emergency Physicians frequently see patients who complain of an allergic reaction to an animal bite or sting. Although Hymenoptera stings, specifically those of wasps, bees, and hornets, account for the majority of these cases, other invertebrates and vertebrates are capable of causing allergic reactions and anaphylaxis. Many of the causative animals are quite unusual, and their bites and stings are not commonly appreciated as potential causes of anaphylaxis. We conducted a literature review to identify documented reports of anaphylaxis and anaphylactoid reactions to animal bites and stings. This summary is meant to heighten awareness of the diversity of animals that may cause anaphylaxis, hopefully leading to more rapid diagnosis and treatment of this dangerous condition. A diverse group of animals was found whose bites and stings cause anaphylaxis and anaphylactoid reactions. Some case summaries are presented. A potentially life-saving plan is to direct patients to proper follow-up care to prevent a future life-threatening reaction, including: prescribing epinephrine and antihistamines with proper instructions for their use; referral to an allergist to determine if skin testing, radioallergosorbent test, and immunotherapy are indicated; and reporting the case to state or local Poison Control Centers. In some cases it may be helpful to consult an entomologist or a pest control service for help in identification and elimination of certain offenders.
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Affiliation(s)
- John H Klotz
- Department of Entomology, University of California, Riverside, California 92521, USA
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17
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Abstract
Most of the encounters with biting and stinging insects result in more or less pronounced localized reactions. Typically, urticarial wheals and papular reactions are observed. Less often local bullous or hemorrhagic or disseminated papular reactions, particularly in children and immunologically naive adults, may be seen. With the exception of bee and wasp venom allergies, immediate-type allergic reactions to arthropod stings and bites are rare. Systemic IgE-mediated hypersensitivity has also been reported from additional hymenoptera species, e.g. hornets, bumble bees and ants. Rare are systemic reactions to mosquitoes, flies or kissing bugs and exceptional from ticks, bed bugs, moths, caterpillars and spiders. A major problem is the often lacking standardization of extracts for skin testing and for the determination of specific IgE. Some of the allergens have been characterized and few of them synthesized using recombinant techniques. Most investigations have been made with whole-body extracts or extracts from salivary glands, while desensitization has rarely been attempted. Currently, primary prevention by avoidance of stings and bites, and adequate instruction of sensitized individuals in the use of emergency drugs are mandatory.
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Affiliation(s)
- Andreas J Bircher
- Allergy Unit, Department of Dermatology, University Hospital Basel, Basel, Switzerland.
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18
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Burke G, Wikel SK, Spielman A, Telford SR, McKay K, Krause PJ. Hypersensitivity to ticks and Lyme disease risk. Emerg Infect Dis 2005; 11:36-41. [PMID: 15705320 PMCID: PMC3294369 DOI: 10.3201/eid1101.040303] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Although residents of Lyme disease-endemic regions describe frequent exposure to ticks, Lyme disease develops in relatively few. To determine whether people who experience cutaneous hypersensitivity against tick bite have fewer episodes of Lyme disease than those who do not, we examined several factors that might restrict the incidence of Lyme disease among residents of Block Island, Rhode Island. Of 1,498 study participants, 27% (95% confidence interval [CI] 23%-31%) reported > or = 1 tick bites, and 17% (95% CI 13%-21%) reported itch associated with tick bite in the previous year. Borrelia burgdorferi infected 23% (95% CI 20%-26%) of 135 nymphal Ixodes scapularis (I. dammini) ticks. The likelihood of Lyme disease infection decreased with >3 reports of tick-associated itch (odds ratio 0.14, 95% CI 0.94-0.03, p = 0.01). Prior exposure to uninfected vector ticks protects residents of disease-endemic sites from Lyme disease.
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Affiliation(s)
- Georgine Burke
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
- University of Connecticut School of Medicine, Hartford, Connecticut, USA
| | - Stephen K. Wikel
- University of Connecticut School of Medicine, Hartford, Connecticut, USA
| | | | - Sam R. Telford
- Harvard University, Cambridge, Massachusetts, USA
- Tufts University School of Veterinary Medicine, North Grafton, Massachusetts, USA
| | - Kathleen McKay
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
- University of Connecticut School of Medicine, Hartford, Connecticut, USA
| | - Peter J. Krause
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
- University of Connecticut School of Medicine, Hartford, Connecticut, USA
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19
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Abstract
Tick bite anaphylaxis has rarely been reported. It may follow the bite of any of the different tick life cycle forms, is related to the release of salivary juices, and may range from mild itch to severe wheeze or shock. Data obtained suggest that it is more common and potentially life threatening than tick paralysis, which is more widely reported. Emergency physicians should recognise this possibility following a tick bite and be prepared to give treatment such as adrenaline rapidly. Patients should be referred to an allergist after recovery.
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Affiliation(s)
- A F Brown
- Department of Emergency Medicine, Royal Brisbane Hospital, Queensland, Australia
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Moneret-Vautrin DA, Beaudouin E, Kanny G, Guérin L, Roche JF. Anaphylactic shock caused by ticks (Ixodes ricinus). J Allergy Clin Immunol 1998; 101:144-5. [PMID: 9449522 DOI: 10.1016/s0091-6749(98)70214-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Beaudouin E, Kanny G, Guerin B, Guerin L, Plenat F, Moneret-Vautrin DA. Unusual manifestations of hypersensitivity after a tick bite: report of two cases. Ann Allergy Asthma Immunol 1997; 79:43-6. [PMID: 9236498 DOI: 10.1016/s1081-1206(10)63082-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ticks are able to transmit, through biting, various viral, parasitic, and bacterial diseases, the best known being Lyme disease due to Borrelia burgdorferi. In addition, ticks may also induce allergic reactions. OBJECTIVE A study of immediate and delayed skin reactions are undertaken to give evidence of an IgE-dependent mechanism. METHODS Two lumbermen reported having had skin reactions following bites by ticks. Skin prick tests and intradermal tests were performed with what was most probably Ixodes ricinus extract in one case. Specific IgE to whole body extract of wood tick were assayed by radioimmunoassay. Histological and immunohistologic examinations of skin biopsy obtained from a pruriginous skin lesion and from a delayed reaction following the intradermal test, were performed. RESULTS One of them had positive immediate reactions to a prick test and an intradermal test with the same extract. Both patients had significant levels of wood tick-specific IgE antibody as well as elevated serum total IgE levels. Histologic examinations of a pruriginous lesion revealed lymphocytic dermal and perivascular infiltration, with evidence of CD8+ T lymphocytes and Langerhans' cells in the perivascular infiltrates. A biopsy of the place of the delayed reaction following the intradermal skin test also showed the presence of dermal and perivascular lymphocytic infiltrates. CONCLUSION IgE-dependent allergy to Ixodes ricinus can explain allergic reactions. Standardized extracts have to be prepared with sufficient amounts of the relevant tick salivary antigens to permit diagnosis by skin and serologic tests of patients, especially lumbermen who may be allergic to Ixodes ricinus.
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Affiliation(s)
- E Beaudouin
- Service de Médecine D, Médecine Interne, Immunologie Clinique et Allergologie, Hôpital Central, Nancy, France
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Bessot J, Kopferschmitt M, de Blay F, Dietemann A, Nirrengarten A, Hutt N, Le Coz C, Bouzouba A, Sainte-Laudy J, Pauli G. Chocs anaphylactiques après morsure de tiques de pigeon (Argas reflexus). À propos de douze cas. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s0335-7457(97)80070-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Stone BF, Shipstone MA, Mason KV, Cunningham M, Wong CW. Efficacy of permethrin in controlling the Australian paralysis tick Ixodes holocyclus and the cat flea Ctenocephalides felis on dogs. Aust Vet J 1994; 71:90-1. [PMID: 8198516 DOI: 10.1111/j.1751-0813.1994.tb03337.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- B F Stone
- University of Queensland, Dept of Child Health, Mater Children's Hospital, South Brisbane
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Van Wye JE, Hsu YP, Lane RS, Terr AI, Moss RB. IgE antibodies in tick bite-induced anaphylaxis. J Allergy Clin Immunol 1991; 88:968-70. [PMID: 1744369 DOI: 10.1016/0091-6749(91)90257-o] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J E Van Wye
- Department of Pediatrics, Stanford University School of Medicine, Calif
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Farge D, Couetil JP, Guillemain R, Viossat I, Chabrier PE, Braquet P, Carpentier A. Atrial natriuretic factor after orthotopic heart transplantation. N Engl J Med 1991; 324:777. [PMID: 1825512 DOI: 10.1056/nejm199103143241118] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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