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FEATURE ARTICLE: Insect allergies - more than a nasty
sting
by Bianca Nogrady and ABC Health &
Wellbeing (Published 24/01/2013)
When it comes to dangerous Australian wildlife you probably
don't think of ants, ticks, wasps or bees, but for some people
these insects can be deadly.
Think 'dangerous Australian animals' and images of snakes,
spiders, box jellyfish or even crocodiles come to mind.
But for a small number of people, the bite or sting of
relatively benign insects, such as ants, ticks, wasps or bees can
be as deadly as any encounter with far more venomous creatures.
Allergic reactions to insect bites or stings are surprisingly
common and can be life threatening, says emergency physician
Professor Simon Brown, head of the Centre for Clinical Research
in Emergency Medicine at the University of Western
Australia.
"Of life-threatening allergic reactions [in Australia], about
a quarter are due to insects, about a quarter are due to drugs
[medications], about a quarter are due to food and about a
quarter we can never find a cause for," says Brown.
Insect allergies kill many more people than food allergies,
Brown says, and are a close second to drug allergy in terms of
fatal reactions. (Interestingly however, in the case of tick red
meat allergies, an insect allergy is linked to the development of
a food allergy.
The Australasian Society of Clinical Immunology and Allergy
(ASCIA) says on average three people die every year from
anaphylaxis caused by insect bites or stings. Brown says this is
roughly the same as the number of deaths caused by snake bite.
Those most at risk are older people or those with severe
breathing difficulties.
What is anaphylaxis?
It's not unusual to have a mild local reaction to an insect
bite or sting, where the bite becomes itchy, red and swells a
little. Some people can also have a rash or large amount of
swelling near the bite or sting. It's unusual for people having
these type reactions to go on and have more serious
reactions.
But sometimes an insect bite or sting will cause a generalised
reaction; symptoms of which are often mild, such as hives. In
other cases, symptoms are more severe, such as difficulty
breathing or a sudden drop in blood pressure, and this
potentially life-threatening reaction is known as
anaphylaxis.
"You start getting hot, flushed, itchy. You might have a
little bit of difficulty breathing, palpitations, heart racing
fast and in the worst case, you might just go unconscious," Brown
says.
Other signs of anaphylaxis include:
- noisy breathing
- swelling of the tongue or throat
- persistent cough or wheeze
- difficulty talking or hoarse voice
- dizziness or collapse
- pale and floppy
Anaphylaxis is a medical emergency and people having this type
of reaction need urgent treatment. (See the ASCIA fact sheet for
information on First Aid Treatment for Anaphylaxis).
More than an itchy bite
In theory, any insect that bites or stings humans can trigger
anaphylaxis in a person who is allergic, says medical
entomologist Dr Cameron Webb.
With stinging insects – such as bees, wasps or ants – the
insect's venom triggers the reaction, while with blood sucking
insects – such as ticks, mosquitoes or bed bugs – their saliva is
the trigger. Stings tend to cause more reactions than
bites.
"[In blood-sucking insects] the anaphylactic-type reactions
tend to be associated with insects that might be having a bigger
blood meal as well and are feeding for longer periods, like a
tick or in some cases bed bugs, but it probably has to do with
the quantity of insects that are biting as well," says Webb,
lecturer with the Faculty of Medicine at University of
Sydney.
Common stinging insect allergies
In outer urban and rural areas, reactions to insect bites or
stings make up a much greater proportion of the cases of
anaphylaxis turning up in emergency rooms.
Honeybees are the most common cause of stinging insect
allergies in Australia, but ticks, wasps and ants are also known
to cause anaphylaxis. The frequency and cause of allergic
reactions can vary depending on where you live.
Brown says honeybees are a problem in south-eastern Australia,
while paper wasps start to become an issue closer to Queensland.
In Western Australia, paper wasps and honeybees are the main
cause of insect anaphylaxis.
"If you're in Tasmania, it's mainly jack jumper ants, followed
by bees and very occasionally European wasps," says Brown, who
headed up the Australian Ant Venom Allergy study.
When researching allergic reactions to Tasmania's jack jumper
ant – Myrmecia pilosula – he found the rate of allergy was
twice that of honeybees; with around 3 per cent of the state's
population having had a significant allergic reaction and
anaphylaxis causing a death roughly every two years.
While native stinging ants are more of a problem in Tasmania
than elsewhere, this allergy occurs in many parts of
Australia.
Ant venom facts
Brown says the three main species of ants that cause
anaphylactic reactions in Australia are:
Jack jumper, hopper ant, jumping jack – Myrmecia
pilosula species complex – There are at least five different
species located in Tasmania, South Australia, Victoria, ACT, NSW
(from the Snowy Mountains up to Armidale in northern NSW) and
Western Australia.
This group is responsible for about 60-80 per cent of stinging
ant anaphylaxis in Australia, particularly in Tasmania.
Researchers have developed a highly effective desensitisation
treatment for people allergic to the M. pilosula species
found in Tasmania. Unfortunately this program isn't available
throughout Australia.
Common bull ant – there are at least four to five
different species including M. forficata (found in
Tasmania, Victoria, NSW), M. gratiosa (Perth WA) and M.
pyriformis (found in Victoria, South Australia and
NSW).
Jumping ant – M. nigrocincta – can be found in
SE Queensland and northern NSW.
There are also at least two other species of jumper ants known
to cause anaphylaxis in Western Australia, including M.
ludlowi.
Other types of ants that can cause an anaphylactic reaction
include greenhead ants – Rhytidoponera metallica – and the
imported fire ant, Solenopsis invicta Buren, both found in
Queensland.
Tick allergies
Already notorious with dog and cat pet owners the Australian
paralysis tick, Ixodes holocyclus has been known to cauce
tick paralysis and tick typhus in humans.
But allergic reactions are the most serious medical condition
likely to result from an encounter with these arachnids, found in
a narrow band along much of the east Australian coastline.
People with a known tick allergy should not attempt to remove a
tick, either by pulling it out or by killing it
chemically.
"You have to be very careful about how you take the tick out,"
says Brown. "Anaphylaxsis occurs usually during tick removal
because people pull it out the wrong way – they squeeze all the
saliva out."
Tick red meat allergy
Ticks have another immunological weapon that has only recently
been discovered.
In certain people, exposure to tick saliva makes them severely
allergic to red meat. Associate Professor Sheryl van Nunen was
one of the first researchers in the world to make the connection,
which is thought to be the result of transfer of a mammalian
protein from the tick to its human host.
"There are three problems with ticks – the first is tick
anaphylaxis, the second is large local reactions and the third is
tick-bite-induced meat anaphylaxis," says van Nunen, senior staff
specialist in Royal North Shore hospital's Department of Clinical
Immunology and Allergy.
This year is expected to be a particularly bad year for tick
bite reactions, thanks to a wet 2011/2012 summer.
"Rainfall determines how many ticks there are the next year,
so I'm seeing seeing five to six people out of 25 patients each
week with tick anaphylaxis or mammalian meat
anaphylaxis."
Living with an allergy
As is always the case with allergies, correct diagnosis is
essential. Speak to your GP if you suspect you have an insect
allergy, they can refer you to an allergy specialist for
diagnosis or further treatment.
Treatment options may include:
Action plan and adrenaline autoinjector (such as an EpiPen®
or Anapen) – people diagnosed with insect anaphylaxis need to
carry these with them all the time.
Immunotherapy – this is only an option for some insect
allergies, eg, honeybee or wasps. This process involves exposing
a person to increasing doses of an allergen over time. The idea
is the immune system becomes used to the allergen and it no
longer provokes an allergic response.
ASCIA recommends people with stinging insect allergies
should:
- always carry their Epipen® and action plan
- wear shoes when they go outside – stings often occur on bare
feet
- wear long sleeves and long pants when walking in the bush,
and gloves when gardening
- avoid provoking insects
- have nests removed by professionals
Finally...Don't forget that for serious allergies, an
Adrenalin Auto-Injector such as the EpiPen® or AnaPen can save
lives in an emergency; and the best way to protect your
Anaphylaxis Auto-Injector is to use one of the Insulated
Activeaide Epipen® cases / AnaPen pouches. Importantly, all of our
holders are branded with medical identifications to ensure the
medication is easy to identify, and most of our products are zip
free, allowing for easy and safe access.
We also carry a great range of medical alert / Medical ID
Jewellery / Jewelry that can give emergency medical experts
guidance about your condition, possibly saving lifes as a
result.
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