Insect allergy

Insect allergy ^{[1] [2]} - allergic reactions that occur when in contact with insects and their metabolites: contact with them, inhalation of particles of the body of insects or their waste products, bites and stings by insects.

ICD10: The ICD code is indicated depending on the nature and location of the allergic reaction. To indicate the cause of the allergy, the additional code “W57 Bite or sting by a non-toxic insect and other non-toxic arthropods” is used.

The following sensitization routes are distinguished:

1. poison when stung by hymenoptera ( wasp , bees , hornets , bumblebees ). The most common severe reactions;

2. ingestion of saliva with double-winged bites;

3. inhalation and contact: exposure to body scales and waste products of lepidoptera , caddis flies , etc. For example, caterpillar dermatitis .

Cross-reactions to contact with insects of the same family or order are possible.

There are toxic and allergic reactions to stinging hymenoptera. At the same time, toxic reactions are noted with multiple stinging by insects. The clinical picture of the toxic reaction is characterized by the presence of intoxication symptoms - headache, chills, nausea, hematological changes, damage to the nervous system (convulsions, paralysis, etc.). An allergic reaction to stinging hymenoptera is IgE- mediated and therefore develops rapidly enough. At the same time, a marked local reaction is noted in the form of hyperemia, edema, urticarial and vesihule rashes (in severe cases, up to tissue necrotization). However, the presence of a pronounced local reaction is optional. Systemic reactions manifest themselves in the form of urticaria, Quincke's edema , bronchospasm, symptoms of rhinitis, anaphylactic shock - the main cause of death. In addition, symptoms of intoxication may be present. Some authors also describe a late sting reaction corresponding to an allergic reaction of type III and IV with damage to the kidneys, liver, blood vessels, nervous system, hemorrhagic vasculitis, and a reaction of the type of serum sickness. It should be noted that the severity of allergic manifestations increases with each episode of stinging.

Allergic reactions are possible with bites of double-winged blood-sucking insects, bugs , mosquitoes , horseflies , mosquitoes , fleas , etc. The reaction is more local in nature and proceeds according to the immunocomplex type or HRT, it can be erythematous, vesicular, necrotic. However, systemic reactions in the form of urticaria, Quincke's edema, bronchospasm, as well as intoxication are possible.

Allergic reactions associated with inhalation or contact with scales and insect waste products are caused by the influence of allergenic components of lepidoptera ( bloodworms , butterflies ), caddis flies, cockroaches , orthopterans ( grasshoppers ), hymenoptera, etc. The clinical picture is mainly caused by respiratory symptoms: rhinitis choking, less commonly dermatitis .

Risk factors for insect allergy are a hereditary predisposition to allergic reactions, as well as work associated with constant contact with insects (apiary, in the barn / on beetles, see Kantariasis / etc.).

The clinical picture is diverse and depends on the route of entry of the allergen into the body, the type and titers of specific antibodies and the reactivity of the body. The most studied insect allergy to stinging bees. According to the time of occurrence and the development mechanism, early (95-98% of cases) and late reactions are distinguished. Early reactions begin immediately or within the first hour of being stung. The earlier the reaction develops, the more difficult it is. By severity, early reactions are divided into 3 degrees. I degree - mild, in which skin itching, hives, swelling of the skin and subcutaneous tissue, mucous membranes (swelling of the tongue and larynx are dangerous), as well as general symptoms (fever, chills, fever, agitation or lethargy) are noted. Arterial hypotension (weakness, dizziness, fainting) may develop. In grade II, symptoms associated with spasms of smooth muscles of internal organs join these manifestations: shortness of breath or suffocation, cramping abdominal pain, nausea, vomiting, diarrhea. Women have pain in the lower abdomen, spotting from the genital tract. Ill degree - severe general allergic reaction - anaphylactic shock.

Late stinging reactions develop after 6-12 hours and are characterized by generalized vasculitis involving the skin vessels, internal organs, and damage to the nervous system in the pathological process (demyelinating process).

With the inhalation pathway of bee allergens, an inhalation form of allergy develops in beekeepers, which manifests itself in the form of allergic rhinitis, conjunctivitis, bronchial asthma. The contact form of allergies is characterized by damage to the skin of the hands in the form of dermatitis when working with bees, frames, propolis. Bee venom, propolis, wax do not cross-react with honey.

Insect allergy to bites of blood-sucking insects is characterized by local reactions and is characterized by polymorphism (urticarial, papular, hemorrhagic, bullous, necrotic forms). On stings of midges the erysipelatous reaction is observed (see. Simulidotoxicosis ). Hypersensitivity of the skin to the secretion of the salivary glands of mosquitoes is manifested by the development of an itchy nodular rash (see Phleboderma ). In rare cases, the bite of even one blood-sucking insect can cause a generalized urticarial rash - urticaria , in extremely rare cases - anaphylactic shock .

Barn and rice weevils contain cantharidin , a derivative of tetrahydrofuran, which causes people to irritate the skin and mucous membranes, vomit, headache and cramps. The most severe poisoning occurs in children.

Products contaminated with caryopsis or the black papillon meal with a pungent smell, even after removal of these insects, cause acute gastrointestinal upsets.

Of the bugs, beetles from the black-family are often found in homes. Several species of this family live in people's homes and warehouses of grain and flour, and are serious pests of stocks. For example, representatives of the genera Tribolium and Tenebrio live in flour and in cereal products (small flour crustacean Tribolium confusum and flour crustacean Tenebrio molitor ). Beetles and larvae are harmful. In addition to material damage, insects are also a source of allergen for humans. Their feces poison food supplies, making them unsuitable for consumption, the insect chitinous cover contains allergens in their characteristics similar to tick allergens (Schegoleva, 1941; Plavilshchikov, 1994).

The beetles of Diamphidia locusta , various species of the genus Paederus , etc. are poisonous. The blood of ladybirds ( Coccinellidae ), red-winged animals ( Lycidae ), soft-body ( Cantharidae ), malas ( Melyridae ), and caddies ( Meloidae ) are especially poisonous. The hemolymph of the small beetles belonging to the genus Paederus is very poisonous (family Staphylinidae ). These carnivorous beetles live on the banks of water bodies and can easily get caught by fishermen fumbling at the place of catch. Accidentally eating even one bug with fish can cause severe poisoning. See Pederin .

The diagnosis of insect allergy is based on the history, clinical picture and results of an allergological examination: skin testing with allergens of the body and hymenoptera venom, laboratory tests - PACT to determine specific IgE for insect allergens, Shelley basophilic test. If a reaction of the immunocomplex type is suspected, an appropriate examination is necessary. Examination of patients with a reaction that occurs when in contact with other insects consists in skin allergological testing (in the presence of diagnostic allergens). The differential diagnosis is carried out with toxic and pseudo-allergic reactions.

Treatment with the development of local reactions is carried out with antihistamines ( suprastin , etc.) and calcium preparations, analgesics are used to reduce pain and burning. Topically applied ointments with glucocorticoids. With a bullous rash, opening of the blisters is shown, followed by treatment of the wound surface with a solution of potassium permanganate. In the case of a general allergic reaction to stinging, it is first necessary to carefully remove the sting. Above the stinging site (if localization allows), a tourniquet should be applied and chipping of the affected area 0.3-0.5 ml of 0.1% adrenaline solution. In addition, another 0.3-0.5 ml of adrenaline is injected subcutaneously. Subsequently, adrenaline is injected every 10-15 minutes until the patient is withdrawn from the collaptoid state. Additionally, you can enter subcutaneously 2 ml of cordiamine or 1 ml of a 10% solution of caffeine-sodium benzoate. After restoration of hemodynamic parameters, antihistamines are used intramuscularly or intravenously: 2 ml of a 2% suprastin solution. Corticosteroid preparations (30-60 mg of prednisone or 100 mg of hydrocortisone hemisuccinate) are administered intramuscularly, in severe cases, intravenously with 10 ml of isotonic sodium chloride solution. To stop bronchospasm, intravenous administration of 10 ml of a 2.4% solution of aminophylline with 10 ml of a 40% glucose solution is recommended. In severe obstruction of the respiratory tract, intubation or tracheotomy or cricothyrotomy is performed, followed by transfer of the patient to mechanical ventilation.

The prognosis is usually favorable. In severe systemic reactions, the prognosis is serious (a fatal outcome is possible with anaphylactic shock, asthmatic status).