• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Insect allergy
 

Insect allergy

on

  • 589 views

definition ,pathology ,diagnosis ,treatment,

definition ,pathology ,diagnosis ,treatment,

Statistics

Views

Total Views
589
Views on SlideShare
589
Embed Views
0

Actions

Likes
1
Downloads
21
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Insect allergy Insect allergy Presentation Transcript

    • Insect AllergyProf. Dr. Saad S Al AniSenior Pediatric ConsultantHead of Pediatric DepartmentKhorfakkan hospitalSharjah ,UAESaadsalani@yahoo.com
    • HistoryThe first reports of stinginginsect allergy came from theMiddle East thousands ofyears ago.Even at that time, peopleunderstood that a small insect,such as a bee or a wasp, had thepotential to cause seriousillness or even death.http://www.theonlineallergist.com19 April 2013 2Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • IntroductionAllergic responses tostinging1. Localized cutaneousreactions2. Systemic anaphylaxis19 April 2013 3Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.Allergic reactions that are causedby inhalation of airborneparticles of insect origin result in:1. Acute or 2.Chronicrespiratory symptoms of seasonalor perennial:i. Rhinitisii. Conjunctivitisiii. Asthma19 April 2013 4Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • EtiologyMost reactions to biting andstinging insects, such as thoseinduced by mosquitoes, flies, andfleas, are limited to a primarylesion isolated to the area of thebite and do not represent anallergic response.19 April 2013 5Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.Occasionally, insect bites or stingsinduce pronounced localizedreactions or systemic reactionsthat may be based on:1. Immediateor2. Delayed hypersensitivityreactions.19 April 2013 6Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.Systemic allergic responsesto insects are attributed mosttypically to immunoglobulin (Ig)Eantibody–mediatedresponses, which are caused:i. Primarily by stings fromvenomous insects of the orderHymenopteraii. More rarely fromticks, spiders, and kissing bug.19 April 2013 7Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.Systemic reactions tostinging insects occur in 0.4-0.8% of children and 3% ofadults19 April 2013 8Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.Members of the orderHymenoptera include:i. Apids:* Honeybee * Bumblebeeii. Vespids* Yellow jacket * Wasp* Hornetiii. Formicids* Fire ants * Harvester ants19 April 2013 9Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Species of Hymenoptera and theirgeographical distribution.Freeman TM: Hypersensitivity Hymenoptera stings, N Engl J Med 351:1978–1984, 2004.)19 April 2013 10Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.Freeman TM: Hypersensitivity Hymenoptera stings, N Engl J Med 351:1978–1984, 2004.)19 April 2013 11Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • PathogenesisLocalized skin responses tobiting insects are causedprimarily by vasoactive orirritant materials derived frominsect saliva, and rarely occurfrom IgE-associated responses19 April 2013 12Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.Systemic IgE-mediated allergicreactions to salivary proteinsof biting insects such asmosquitoes are reported butuncommon.19 April 2013 13Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.IgE antibody–mediated allergicresponses to airborneparticulate mattercarrying insect emanationscontribute to:1. Seasonal2. Perennialsymptoms affecting the upperand lower airways19 April 2013 14Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Seasonal allergyAttributed to exposures to avariety of insects, particularlyaquatic insects such as the caddisfly and midge, or lake fly, at atime when larvae pupate andadult flies are airborne19 April 2013 15Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Perennial allergyAttributed to sensitizationto insects such as cockroachesand ladybugs as well as housedust mite19 April 2013 16Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Hymenoptera venomsContain numerous componentswith toxic and harmacologicactivity and with allergenicpotential.These constituents include:1.Vasoactive substances such ashistamine, acetylcholine, andkinins2.Enzymes such as phospholipaseand hyaluronidase3.Apamin4. Melittin5. formic acid19 April 2013 17Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.The majority of patients whoexperience systemic reactionsafter Hymenoptera stings haveIgE-mediated sensitivity toantigenic substances in thevenom.19 April 2013 18Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • i. Honey bees are only capable ofstinging a person once.Honey Beeiii. As the honey bee flies away, itbecome eviscerated and dies.ii. The honey bee is the onlystinging insect that leaves itsstinger and venom sac in theskin of its victim, due to thebarbed configuration of thestinger.http://www.theonlineallergist.com19 April 2013 19Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Yellow Jacketi. Wasp-like insects that live inmounds built into the groundiii. They are commonly foundaround garbage cans andpicnic areas where food andsugary drinks are abundantii. They tend to be very aggressiveinsects, and will often stingwithout provocation.http://www.theonlineallergist.com19 April 2013 20Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • HornetHornets, including yellow and white-faced hornets, build paper- mache typenests in trees and shrubsSome hornets look very much likeyellow jackets and can be difficult todistinguishThese insects may be very aggressive,and a sting may be provoked by a minordisruption in their environment.http://www.theonlineallergist.com19 April 2013 21Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • WaspsWasps build honey-comb nestsunder the eaves of a house, or in atree, shrub or under patiofurniture.They tend to be less aggressivethan yellow jackets andhornets, and mostly feed oninsects and flower nectar.http://science.howstuffworks.comhttp://www.theonlineallergist.com19 April 2013 22Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • BumblebeesBumblebees rarely sting peoplebecause they are non-aggressiveand typically mild manneredThey generally will sting only ifprovokedThey nest in the ground or in piles ofgrass clippings or woodhttp://www.theonlineallergist.com19 April 2013 23Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Fire AntFire Ant bites are generally quite painfulThe bite of a fire ant characteristicallyWill form into a white pustule withina day or twoScratching these pustules can lead tolocal infection and scarsIt is not unusual to sustain multiplebites, generally on the feet and handshttp://www.theonlineallergist.com19 April 2013 24Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Clinical ManifestationsInsect bites are usually urticarialbut may be papular or vesicularPapular urticaria affecting the lowerextremities in children is usually causedby multiple bitesIgE antibody–associated immediate- andlate-phase allergic responses to mosquitobites sometimes mimic cellulitis19 April 2013 25Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Clinical reactions to stingingvenomous insectsAre categorized as:6.Delayed/Late1. Local2. Large local3. Generalized cutaneous4. Systemic5. toxic19 April 2013 26Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.1.Simple local reactionsi. Involve limited swellingii. Painiii. Generally last <24 hr.2.Large local reactionsi. Develop over hours and daysii. involve swelling of extensiveareas (>10 cm) that arecontiguous with the sting siteiii. May last for days19 April 2013 27Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.3.Generalized cutaneous reactionsTypically progress within minutes andinclude cutaneous symptoms of :i. Urticaria ii. Angioedemaiii. Pruritusbeyond the site of the sting4.Systemic reactionsare identical to anaphylaxis from othertriggers and may include symptoms of :i. Generalized urticariaii .Laryngeal edemaiii. Bronchospasmiv. Hypotension19 April 2013 28Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.5. Toxic reactionsStings from a large number of insects atonce may result in toxic reactions of :i. Fever ii. Malaise iii. Emesis iv. Nauseaowing to the chemical properties of thevenom in large doses.6.Delayed/Late reactionsi. Serum sicknessii. Nephrotic syndromeiii. Vasculitisiv. Neuritisv. Encephalopathymay occur as delayed/late reactions tostinging insects19 April 2013 29Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Inhalant allergyCaused by insects results in clinicaldisease similar to that induced byother inhalant allergens such aspollensDepending on individual sensitivityand exposure, reactions may result inseasonal or perennialrhinitis, conjunctivitis, and asthma19 April 2013 30Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • DiagnosisGenerally evident from:i. History of exposureii. Typical symptomsiii. Physical findingsThe diagnosis of Hymenoptera allergyrests in part on the identification ofvenom-specific IgE by prick skin testing19 April 2013 31Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.The primary reasons to pursue testingare to confirm reactivity when:i. Venom immunotherapy (VIT) isbeing consideredii. It is clinically necessary to confirmvenom hypersensitivity as a cause ofa reaction19 April 2013 32Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont. Venoms of five Hymenoptera (1.Honeybee2.Yellow jacket3. Yellow hornet4. White-faced hornet5. Wasp)as well as the jack jumper antand whole-body extract of fire antare available for skin testingSkin tests are usually accurate within1 wk of a sting reaction, butoccasionally a refractory period isobserved that warrants retesting after 4-6 wk if the initial results are negative19 April 2013 33Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • The diagnosis of inhalantinsect allergyMay be evident from a history oftypical symptoms inducedseasonally in specific geographicregionsSkin prick or in vitroimmunoassay tests for specificIgE to the insect are used toconfirm inhalant insect allergy19 April 2013 34Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Treatmenti. Cold compressesii. Topical medications to relieve itchingiii. occasionally the use ofa. systemic antihistamineb. oral analgesicare appropriateStingers should be removed promptly byscraping, with caution not to squeeze thevenom sac because doing so could injectmore venomFor local cutaneous reactions19 April 2013 35Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.Sting sites rarely becomeinfected, possibly owing to theantibacterial actions of venomconstituentsVesicles left by fire ant stings thatare scratched open should becleansed to prevent secondaryinfection19 April 2013 36Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.Therapies may include:i. Oxygenii. Epinephrineiii. Intravenous salineiv. Steroidsv. AntihistaminesAnaphylactic reactions19 April 2013 37Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • VenomImmunotherapy(VIT)Hymenoptera VIT is highlyeffective (95-97%) in decreasingthe risk for severe anaphylaxis.The selection of patients for VITdepends on several factors19 April 2013 38Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Indications for venom immunotherapyagainst winged HymenopteraSYMPTOMS AGESKIN TEST/IN VITROTESTRISK OFSYSTEMICREACTION IFUNTREATED(%)*VITRECOMMENDEDLarge localreactionAny Usually not indicated 4-10Usually notindicatedGeneralizedcutaneousreaction≤16 yr Usually not indicated 9-10Usually notindicated≥17 yrPositive result 20 YesNegative result — NoSystemicreaction AnyPositive resultChild: 40Adult: 60-70YesNegative result— Usually no*Risks generally decrease after 10 yr19 April 2013 39Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • PreventionAvoidance of stings and bites is essentialTo reduce the risk of stings,sensitized individuals should:i. Avoid attractants such asperfumes and bright-coloredclothing outdoorsii. Wear gloves when gardeningiii. Wear long pants and shoeswith socks when walking inthe grass or through fields19 April 2013 40Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.Typical insect repellents do notguard against Hymenoptera.Nests of these insects should beremoved if they are close to thehome19 April 2013 41Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.Individuals who have hadgeneralized cutaneous orsystemic reactions toHymenoptera stings shouldhave immediate access to self-injectable epinephrineThe individual at risk foranaphylaxis from an insectsting should also wear anidentification braceletindicating the allergy19 April 2013 42Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • Cont.Avoidance of the insect is thepreferred management ofinhalant allergyImmunotherapy is occasionallyundertaken in such cases, butbeneficial results have not beenthoroughly documented.19 April 2013 43Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE
    • References19 April 2013 44Insect Allergy Prof. Dr. Saad S Al AniKhorfakkan Hospital ,Sharjah ,UAE1. http://www.acaai.org/allergist/allergies/types/insect-sting-allergies2. http://www.theonlineallergist.com3. Freeman TM: HypersensitivityHymenoptera stings, N Engl J Med 351:1978–1984, 2004.)4. http://www.webmd.com/allergies/guide/insect-stings5. http://www.aaaai.org/conditions-and-treatments/library/allergy-library/stinging-insect-allergy6. http://science.howstuffworks.com7. Scott H. Sicherer,Donald Y.M. Leung. InsectAllergy.(In) Robert M. Kliegman, MD, andRichard E. Behrman, MD. Nelson Textbook ofPediatrics - Chapter 140