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Chap. 14 - LIFE-THREATENING STINGS, BITES, AND MARINE ENVENOMATIONS

Published online by Cambridge University Press:  07 September 2011

By
Dirk M. Elston
Edited by
Ronni Wolf ,
Batya B. Davidovici ,
Jennifer L. Parish  and
Lawrence Charles Parish
Dirk M. Elston
Affiliation:
Geisinger Medical Center
Ronni Wolf
Affiliation:
Kaplan Medical Center, Rehovot, Israel
Batya B. Davidovici
Affiliation:
Kaplan Medical Center, Rehovot, Israel
Jennifer L. Parish
Affiliation:
Jefferson Medical College of Thomas Jefferson University
Lawrence Charles Parish
Affiliation:
Jefferson Medical College of Thomas Jefferson University
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Summary

BITES AND STINGS

Major causes of death related to arthropod bites and stings include anaphylaxis, reactions to venom, and vector-borne disease. This chapter addresses each of these causes.

ANAPHYLAXIS

Background

Anaphylaxis related to insect stings is estimated to occur in 3 of every 100 adults.

Clinical and Laboratory

Skin tests can be used to verify a history of sting allergy. Radioallergosorbent testing (RAST) is less sensitive, but does not carry a risk of anaphylaxis during the testing. It is important to note that neither the size of a skin test reaction nor the RAST level is a reliable predictor of the severity of subsequent sting reactions. In vitro methods of testing also include western blot and in vitro basophil activation tests that measure histamine and sulphidoleukotrien released (Cellular Antigen Stimulation Test [CAST]) or activation markers on the cell surface detected by means of flow cytometric analysis (Flow CAST). Basophil activation tests using either CD63 or CD203c show promise in the in vitro diagnosis of patients with bee or wasp venom allergy.

Patients with mastocytosis who develop severe hypotension after wasp or bee stings typically do not demonstrate specific immunoglobulin E (IgE). Similar patients have been described with no skin lesions to suggest mastocytosis. In some patients, serum tryptase elevations suggest subclinical mastocytosis, and bone-marrow biopsy may reveal systemic mastocytosis.

Type
Chapter
Information
Emergency Dermatology , pp. 146 - 153
Publisher: Cambridge University Press
Print publication year: 2011

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