The article [1] and editorial [2] about insect-sting anaphylaxis add much to an oft-neglected but serious medical situation. During the 4 years I lived in Mississippi, I experienced three episodes of progressive, worsening allergic reactions to fire-ant stings.

Each episode resulted from several stings by more than one ant. This behavior is typical of fire ants, which will sting repeatedly until removed [3]. The first episode resulted in a local cutaneous reaction with erythema. The second episode resulted in the formation of a 1-cm bulla, lasting for a week and leaving a permanent scar. The third episode was systemic, with the development of a body rash, a feeling of faintness, tachycardia, and shortness of breath, and occurred within 15 minutes of the stings. Fortunately, an oral dose of diphenhydramine hydrochloride, 50 mg, caused the symptoms to resolve. The last episode resulted in two bullae of smaller size.

This anecdote is a cautionary tale about insect stings. Although van der Linden and colleagues [1] concluded that recurrent anaphylactic reactions occurred in only 28% of the study patients with a previous reaction, Valentine's cited rate [2] of 40% to 74% may be more realistic. I should add that I have also been stung by mosquitoes, yellow jackets, wasps, and horseflies. Although none of these experiences has been pleasant, my allergic responses to each type of insect differed in severity and type, but none was as severe as my reaction to fire ants.

Future research should look into the epidemiology of insect stings, using indices such as types of allergic responses and their relation to age, heredity, venom dose, and so forth; the classes of insect venom and their cross-reactivity; and the best means of inducing immunity.