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Arthropod Allergy

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Overview of arthropods that can cause allergic reactions, such as ticks, mites, and insects.

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Arthropod Allergy

  1. 1. Nathan Hare MD, FAAAAI Allergy Partners of Lewisburg 10/29/14 http://goo.gl/Sq5WiU
  2. 2. • None
  3. 3. This presentation is designed to present an overview of this topic. This presentation is for informational and educational purposes only. Those involved in the creation of this presentation, including Nathan Hare, M.D. and Allergy Partners, PA, will not be held responsible for any treatment taken by viewers as a result of their interpretations of the information provided.
  4. 4. • Arthropods: Insects vs. arachnids • What is an allergy? • What is anaphylaxis? • What symptoms are consistent with an allergic reaction? • Management of anaphylaxis • Routes of exposure for an allergic reaction • Review of arthropod reactions • Route of exposure • Types of reactions • Management
  5. 5. • “an organism with … three body regions– head, thorax, and abdomen.” • It has 6 legs • It has “a pair of antennae and external mouthparts.” http://insects.about.com/od/insects101/p/whatisaninsect.htm
  6. 6. http://insects.about.com/od/insects101/ss/howtoidaninsect.htm
  7. 7. http://goo.gl/vTpeQQ
  8. 8. • They have “two distinct regions, the cephalothorax and the abdomen.” • They have 8 legs. • They “lack wings and antennae.” http://insects.about.com/od/noninsectarthropods/p/arachnida.htm
  9. 9. http://goo.gl/vTpeQQ http://goo.gl/7m3UFh http://goo.gl/7MITvk http://goo.gl/MhEGXq http://goo.gl/kMl3Yg
  10. 10. • The immune system reacts to something harmless (allergen) • It thinks that the allergen is dangerous • Symptoms are caused by the immune system trying to defend the body • “Hypersensitivity”
  11. 11. • Irritation • Tarantula hairs • Envenomation (poison) • Caterpillars with poisonous spines • Saddleback caterpillar • Puss Caterpillar • Spider bites Black widow Brown recluse http://goo.gl/XzLTw4 Puss Caterpillar
  12. 12. • A rapid, sudden onset, life-threatening, allergic reaction.
  13. 13. • Mouth: Itchy, swelling of tongue and/or lips • Throat: Itchy, tightness/closure, hoarseness, trouble breathing/swallowing • Skin: Itchy, hives, redness, swelling, red watery eyes • Gut: Nausea, vomiting, cramps, diarrhea • Lung: Short of breath, wheeze, repetitive cough • Heart: Pale or blue skin color, dizzy/faint, weak pulse • Neurological: Sense of “impending doom,” irritability, change in alertness, mood change, http://goo.gl/Fp12Sp
  14. 14. • Epinephrine • Epinephrine • Epinephrine • Antihistamines • Oxygen • Airway support
  15. 15. • Epinephrine (repeat in 5 minutes if no improvement) • ~25% of the time a second dose is needed • “If there is any doubt, it is generally better to administer epinephrine.” • Benadryl • “H1 antihistamines are considered second line to epinephrine and should not be administered in lieu of epinephrine in the treatment of anaphylaxis.” http://goo.gl/oDh4CD
  16. 16. • Immediate • Delayed
  17. 17. • Bites • Contact / Touch • Inhalation / Breathing • Injection / Sting • Ingestion / Eating
  18. 18. Immediate Delayed http://goo.gl/v0lnnm Latex Poison Ivy
  19. 19. • Immediate www.doctorfungus.org http://goo.gl/2ZKoUx
  20. 20. • Immediate http://goo.gl/DVvcSJ
  21. 21. • Immediate • Delayed http://goo.gl/mNRDPv
  22. 22. Public Domain: Mosquito, James Gathany, 2005 (CDC) http://goo.gl/tXXSiO • Exposure: Bites • Type of Reaction: Allergic (delayed or immediate) • Symptoms: • Local allergic reaction • Large local reaction (Skeeter Sydrome) • Rarely, hives, anaphylaxis, or other immune reaction • Treatment: Symptomatic http://goo.gl/SanNFh UpToDate: Author F Estelle R Simons, MD, FRCPC Large local reactions to mosquito bites (Skeeter syndrome)
  23. 23. • Black Flies, Horse Flies • Exposure: Bites • Type of Reaction • Allergic (delayed or immediate) • Symptoms: • Local allergic reaction • Anaphylaxis • Black Flies: Late systemic syndrome characterized by fever, leukocytosis, lymphadenitis, and papular lesions. • Treatment: Symptomatic http://goo.gl/wWieEi UpToDate: Insect bites Author Mariana C Castells, MD, PhD http://goo.gl/QE3GDW
  24. 24. • larvae of the Trombiculidae family, a type of mite • Exposure: Bites • Type of Reaction: Allergic (delayed, possibly immediate) • Symptoms: • Local allergic reaction • Rarely, hives, blistering or other rash • Treatment: Symptomatic By: CDC/ Dr. Cornelius B. Philip, Nat. Inst. of Allergy and Infectious Diseases (NIAID), Rocky Mountain Laboratories (RML), Courtesy: Public Health Image Library http://goo.gl/m0cEjp http://goo.gl/fBWgp8 UpToDate: Chigger bites Authors:Helge Riemann, MD Whitney A High, MD http://goo.gl/vBTHsr
  25. 25. • Exposure: Bites and Burrows • Type of Reaction: Allergic (delayed-type) • Symptoms: • Local allergic reaction • Diffuse itching, worse at night • Treatment: • Symptomatic • Eradication with medication (oral ivermectin, topical permethrin) http://goo.gl/BlCJ23 UpToDate: Scabies Authors: Beth G Goldstein, MD, Adam O Goldstein, MD, MPH http://goo.gl/s2daHI
  26. 26. • Exposure: Bites • Type of Reaction: Allergic (delayed) • Symptoms: • Local allergic reaction • Treatment: • Symptomatic • Eradication By: CDC/ Harvard University, Dr. Gary Alpert; Dr. Harold Harlan; Richard Pollack, Courtesy: Public Health Image Library http://goo.gl/z0XZps
  27. 27. • Exposure: Bites • Type of Reaction: Allergic (delayed) • Symptoms: • Local Allergic Reaction • Treatment: Symptomatic UpToDate: Insect bites Author Mariana C Castells, MD, PhD http://goo.gl/QE3GDW http://goo.gl/IwwKUZ
  28. 28. • Exposure: Bites • Type of Reaction: Irritation, Allergic (delayed or immediate) • Symptoms: • Rarely, anaphylaxis • Development of a meat allergy related to sensitization to a carbohydrate in the tick’s saliva • Treatment: Symptomatic http://goo.gl/7MITvkUpToDate: Insect bites Author Mariana C Castells, MD, PhD http://goo.gl/QE3GDW
  29. 29. • Exposure: Bites • Type of Reaction: Allergic (delayed or immediate) • Symptoms: • Local allergic reaction • Rarely, respiratory symptoms, especially if cat allergic • Treatment: • Symptomatic • Eradication By: CDC/ Janice Haney Carr, Courtesy: Public Health Image Library http://goo.gl/N7xiLC UpToDate: Insect bites Author Mariana C Castells, MD, PhD http://goo.gl/QE3GDW
  30. 30. • Exposure: Contact, Bites, Inhalation • Type of Reaction: Allergic (immediate) • Symptoms: • Eye and Nose Symptoms • Chronic cough • Asthma • Hives / Swelling • Treatment: • Symptomatic • Eradication http://goo.gl/EfR91b Nakazawa T1, Satinover SM, Naccara L, Goddard L, Dragulev BP, Peters E, Platts-Mills TA. Asian ladybugs (Harmonia axyridis): a new seasonal indoor allergen. J Allergy Clin Immunol. 2007 Feb;119(2):421-7.
  31. 31. • A scale insect that lives on cacti in Central and South America • Used to make Red Dye for food coloring, cosmetics • Cochineal, or Carmine • Exposure: Contact, Inhalation, Ingestion • Type of Reaction: Allergic (delayed or immediate) • Symptoms: • Asthma • Hives • Anaphylaxis • Contact Dermatitis • Treatment: • Symptomatic • Avoidance http://goo.gl/oI6SF9 http://goo.gl/Guwo7j
  32. 32. • Exposure: Inhalation, Contact, Ingestion (chocolate, peanut butter, macaroni, fruit, cheese, popcorn and wheat) • Type of Reaction: Allergic (immediate) • Symptoms: • Eye and Nose Symptoms • Asthma • Treatment: • Symptomatic • Eradication • Allergy Immunotherapy http://goo.gl/RNBRb3 By: CDC, Courtesy: Public Health Image Library Per ABC news: Average chocolate bar has 8 insect parts http://goo.gl/q8B1W
  33. 33. • 0.3 mm long • 8 legs • Sightless • Live on skin scales • Entirely dependent on ambient humidity for their moisture • Optimum growth at 65- 80oF • Mite fecal pellet • Source of allergens • 10-35 μm • Dermatophygoides farinae • D. pteronyssinus • D. microceras • Blomia tropicalis • Florida in the US
  34. 34. • Exposure: Inhalation, Contact • Type of Reaction: Allergic (immediate) • Symptoms: • Eye and Nose Symptoms • Asthma • Treatment: • Symptomatic • Avoidance – Environmental Modifications • Allergy Immunotherapy http://goo.gl/kMl3Yg
  35. 35. • 2010 Cochrane Review, assessed as up to date end of 2009.1 • 9 trials (501 participants satisfied criteria) • Mite-impermeable bedding covers (2 studies were good quality) • Acaricides (2 studies) • HEPA filters (2 studies) • Acaricides +/- covers (1 study) 1. Aziz Sheikh1,*, Brian Hurwitz2, Ulugbek Nurmatov3, Constant Paul van Schayck4 Editorial Group: House dust mite avoidance measures for perennial allergic rhinitis Cochrane Ear, Nose and Throat Disorders Group Published Online: 7 JUL 2010 Assessed as up-to-date: 30 DEC 2009
  36. 36. • Conclusions: • Trials to date … small and of poor methodological quality…difficult to offer any definitive recommendations on the role … of house dust mite avoidance measures in the management of house dust mite sensitive perennial allergic rhinitis. • Use of acaricides and extensive bedroom-based environmental control programmes may be of some benefit in reducing rhinitis symptoms and, if considered appropriate, these should be the interventions of choice. • Isolated use of house dust mite impermeable bedding is unlikely to prove effective. 1. Aziz Sheikh1,*, Brian Hurwitz2, Ulugbek Nurmatov3, Constant Paul van Schayck4 Editorial Group: House dust mite avoidance measures for perennial allergic rhinitis Cochrane Ear, Nose and Throat Disorders Group Published Online: 7 JUL 2010 Assessed as up-to-date: 30 DEC 2009
  37. 37. • Honeybees • Wasps • Yellow jackets / hornets • Fire ants
  38. 38. http://goo.gl/vTpeQQ
  39. 39. http://goo.gl/npB2bE
  40. 40. http://goo.gl/BaVTND By: CDC/ Harvard University, Dr. Gary Alpert, Courtesy: Public Health Image Library http://goo.gl/g4HSm3
  41. 41. http://goo.gl/ItNZxe
  42. 42. • An estimated 0.4-0.8% of children, and 3% of adults, have potentially life-threatening reactions to stings. • Honey Bee • Yellow Jacket • Yellow-Faced Hornet • White-Faced Hornet • Paper Wasp • Fire Ant http://goo.gl/wi7PFc
  43. 43. • Stinging insects such as bees, wasps, hornets and yellow jackets, are most active during late- summer and early-autumn • Fire ants are prevalent year round in the South http://goo.gl/povKLP http://goo.gl/YXhxoP
  44. 44. • Analysis of the National Mortality Database • 2458 fatal anaphylaxis cases in the U.S. of all causes • 0.69 persons per million Jerschow E1, Lin RY2, Scaperotti MM3, McGinn AP4. Fatal anaphylaxis in the United States, 1999-2010: Temporal patterns and demographic associations. J Allergy Clin Immunol. 2014 Sep 26. pii: S0091-6749(14)01190-7. doi: 10.1016/j.jaci.2014.08.018. [Epub ahead of print]
  45. 45. • Rate • Differed by race • 0.14 per million in white subjects • 0.05 per million in African American subjects • 0.03 per million in Hispanic subjects • Increased with age • 0.01 per million if ≤ 19 years • 0.20 per million if age 60 to 79 years Jerschow E1, Lin RY2, Scaperotti MM3, McGinn AP4. Fatal anaphylaxis in the United States, 1999-2010: Temporal patterns and demographic associations. J Allergy Clin Immunol. 2014 Sep 26. pii: S0091-6749(14)01190-7. doi: 10.1016/j.jaci.2014.08.018. [Epub ahead of print]
  46. 46. • Rate • Differed by gender • 0.18 per million for male subjects • 0.04 per million for female subjects • no significant increase over time Jerschow E1, Lin RY2, Scaperotti MM3, McGinn AP4. Fatal anaphylaxis in the United States, 1999-2010: Temporal patterns and demographic associations. J Allergy Clin Immunol. 2014 Sep 26. pii: S0091-6749(14)01190-7. doi: 10.1016/j.jaci.2014.08.018. [Epub ahead of print]
  47. 47. • Children <16 years of age • Family History: No evaluation needed • Never had a reaction: No evaluation needed • Local reaction only: No evaluation needed • Skin reaction only: No evaluation needed Epinephrine auto-injector not needed • Anaphylaxis: Evaluation needed Epinephrine auto-injector needed Golden DB1, Moffitt J, Nicklas RA, Freeman T, Graft DF, Reisman RE, Tracy JM, Bernstein D, Blessing-Moore J, Cox L, Khan DA, Lang DM, Oppenheimer J, Portnoy JM, Randolph C, Schuller DE, Spector SL, Tilles SA, Wallace D; Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma & Immunology (AAAAI); American College of Allergy, Asthma & Immunology (ACAAI); Joint Council of Allergy, Asthma and Immunology. J Allergy Clin Immunol. Stinging insect hypersensitivity: a practice parameter update 2011. 2011 Apr;127(4):852-4.e1-23. doi: 10.1016/j.jaci.2011.01.025.
  48. 48. • Adults and Children ≥16 years of age • Local reaction only: No evaluation needed • Skin reaction (hives and swelling): Increased risk of anaphylaxis Evaluation needed Epinephrine auto-injector needed • Anaphylaxis: Evaluation needed Epinephrine auto-injector neededGolden DB1, Moffitt J, Nicklas RA, Freeman T, Graft DF, Reisman RE, Tracy JM, Bernstein D, Blessing-Moore J, Cox L, Khan DA, Lang DM, Oppenheimer J, Portnoy JM, Randolph C, Schuller DE, Spector SL, Tilles SA, Wallace D; Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma & Immunology (AAAAI); American College of Allergy, Asthma & Immunology (ACAAI); Joint Council of Allergy, Asthma and Immunology. J Allergy Clin Immunol. Stinging insect hypersensitivity: a practice parameter update 2011. 2011 Apr;127(4):852-4.e1-23. doi: 10.1016/j.jaci.2011.01.025.
  49. 49. • Venom allergy immunotherapy • Decreases risk of anaphylaxis from 30-60% to <5% • Venom Allergy Anaphylaxis Action Plan • Have injectible epinephrine on hand (2 doses) • Medical Alert Bracelet • Behavior modifications to reduce risk of exposure Golden DB1, Moffitt J, Nicklas RA, Freeman T, Graft DF, Reisman RE, Tracy JM, Bernstein D, Blessing-Moore J, Cox L, Khan DA, Lang DM, Oppenheimer J, Portnoy JM, Randolph C, Schuller DE, Spector SL, Tilles SA, Wallace D; Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma & Immunology (AAAAI); American College of Allergy, Asthma & Immunology (ACAAI); Joint Council of Allergy, Asthma and Immunology. J Allergy Clin Immunol. Stinging insect hypersensitivity: a practice parameter update 2011. 2011 Apr;127(4):852-4.e1-23. doi: 10.1016/j.jaci.2011.01.025.
  50. 50. • Insects have 3 body segments, 6 legs and 2 antennae • Arachnids have 2 body segments, 8 legs, and no antennae • An Allergic reaction is an immune reaction to a trigger • Allergic reactions to arachnids can occur through contact, bites, inhalation, ingestion, and injection.
  51. 51. • Allergic reactions to arachnids can range from mild and local, to severe, life-threatening and systemic • Venom allergy immunotherapy can greatly reduce the future risk of anaphylaxis • Epinephrine is the treatment of choice for anaphylaxis
  52. 52. Questions? Comments? Nathan Hare MD, FAAAAI 570-522-8111 (office) ndhare@allergypartners.com @AllergyTalk, @ AP_Lewisburg https://www.facebook.com/APLewisburg

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