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Selecting Patients for Insect Venom Immunotherapy
- Betty C. Jung, MD
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TO THE EDITOR:
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.
Betty C. Jung
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
