Hymenoptera stings: Difference between revisions
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==Class Hymenoptera== | ==Class Hymenoptera== | ||
*All Hymenoptera share similar components in their venonm and patients can have allergies across the subgroups<ref name="King">King TP et al. Structure and biology of stinging insect venom allergens. Int Arch Allergy Immunol. 2000;123(2):99-106</ref> | *All Hymenoptera share similar components in their venonm and patients can have allergies across the subgroups<ref name="King">King TP et al. Structure and biology of stinging insect venom allergens. Int Arch Allergy Immunol. 2000;123(2):99-106</ref> | ||
*Most reactions are local but anaphylaxis and serum sickness are possible | *Most reactions are local but anaphylaxis and serum sickness are possible | ||
==Bees (Apids)== | ==Clinical Features== | ||
===Bees (Apids)=== | |||
*Include Bumblebees and Honeybees | *Include Bumblebees and Honeybees | ||
*Barbed Stingers - remain in victims and the process of stinging kills the bee | *Barbed Stingers - remain in victims and the process of stinging kills the bee | ||
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*redness and irritation last 1-3 days | *redness and irritation last 1-3 days | ||
==Wasps (Vespids)== | ===Wasps (Vespids)=== | ||
*Include Yellow Jackets, Hornets, and Wasps | *Include Yellow Jackets, Hornets, and Wasps | ||
*Non barbed stinger - can sting multiple times and the sting does not cause the wasps' death | *Non barbed stinger - can sting multiple times and the sting does not cause the wasps' death | ||
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*redness and irritation last 1-3 days | *redness and irritation last 1-3 days | ||
==Fire Ants (Formicidae)== | ===Fire Ants (Formicidae)=== | ||
*Alkaloid venom | *Alkaloid venom | ||
*Intense burning papules that may turn to pustules in 24hrs | *Intense burning papules that may turn to pustules in 24hrs | ||
*Localized necrosis has also been reported<ref>Fernández-Meléndez S. et al. Anaphylaxis caused by imported red fire ant stings in Málaga, Spain. J Investig Allergol Immunol. 2007;17(1):48-49</ref> | *Localized necrosis has also been reported<ref>Fernández-Meléndez S. et al. Anaphylaxis caused by imported red fire ant stings in Málaga, Spain. J Investig Allergol Immunol. 2007;17(1):48-49</ref> | ||
==Differential Diagnosis== | |||
{{Bites and stings DDX}} | |||
==Diagnosis== | |||
==Treatment== | ==Treatment== | ||
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*Oral [[Antihistamines]] provide symptom relief for pruritus | *Oral [[Antihistamines]] provide symptom relief for pruritus | ||
*EpiPen should be prescribed on discharge | *EpiPen should be prescribed on discharge | ||
==References== | |||
<references/> | |||
==Review Questions== | ==Review Questions== | ||
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-whether the patient is on oral steroid treatment | -whether the patient is on oral steroid treatment | ||
</quiz> | </quiz> | ||
[[Category:Environ]][[Category: Tox]] | [[Category:Environ]][[Category: Tox]] | ||
Revision as of 03:42, 29 August 2015
Class Hymenoptera
- All Hymenoptera share similar components in their venonm and patients can have allergies across the subgroups[1]
- Most reactions are local but anaphylaxis and serum sickness are possible
Clinical Features
Bees (Apids)
- Include Bumblebees and Honeybees
- Barbed Stingers - remain in victims and the process of stinging kills the bee
- Killer bees (hybridized African Bees) have small individual toxin potency but attack in large numbers with increased aggression[2]
- Main allergen is phospholipase A2, hyaluronidase and melittin[1]
- redness and irritation last 1-3 days
Wasps (Vespids)
- Include Yellow Jackets, Hornets, and Wasps
- Non barbed stinger - can sting multiple times and the sting does not cause the wasps' death
- Histamine, phospholipase, antigen 5, and bradykinin similar to bees[1]
- redness and irritation last 1-3 days
Fire Ants (Formicidae)
- Alkaloid venom
- Intense burning papules that may turn to pustules in 24hrs
- Localized necrosis has also been reported[3]
Differential Diagnosis
Envenomations, bites and stings
- Hymenoptera stings (bees, wasps, ants)
- Mammalian bites
- Closed fist infection (Fight bite)
- Dog bite
- Marine toxins and envenomations
- Toxins (ciguatera, neurotoxic shellfish poisoning, paralytic shellfish poisoning, scombroid, tetrodotoxin
- Stingers (stingray injury)
- Venomous fish (catfish, zebrafish, scorpion fish, stonefish, cone shells, lionfish, sea urchins)
- Nematocysts (coral reef, fire coral, box jellyfish, sea wasp, portuguese man-of-war, sea anemones)
- Phylum porifera (sponges)
- Bites (alligator/crocodile, octopus, shark)
- Scorpion envenomation
- Reptile envenomation
- Spider bites
Diagnosis
Treatment
- Immediate treatment for Anaphylaxis or Allergic Reaction
- Local wound care and tetanus prophylaxis
- Remove stingers to reduce venom exposure
- Oral Antihistamines provide symptom relief for pruritus
- EpiPen should be prescribed on discharge
References
- ↑ 1.0 1.1 1.2 King TP et al. Structure and biology of stinging insect venom allergens. Int Arch Allergy Immunol. 2000;123(2):99-106
- ↑ Díaz-Sánchez C. et al. Suvival after massive (>2000) Africanized Honey bee stings. Arch Intern Med. 1998;158(8):925-927
- ↑ Fernández-Meléndez S. et al. Anaphylaxis caused by imported red fire ant stings in Málaga, Spain. J Investig Allergol Immunol. 2007;17(1):48-49
Review Questions