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Blank S, Korošec P, Slusarenko BO, Ollert M, Hamilton RG. Venom Component Allergen IgE Measurement in the Diagnosis and Management of Insect Sting Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00773-6. [PMID: 39097146 DOI: 10.1016/j.jaip.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/03/2024] [Accepted: 07/15/2024] [Indexed: 08/05/2024]
Abstract
Accurate identification of allergy-eliciting stinging insect(s) is essential to ensuring effective management of Hymenoptera venom-allergic individuals with venom-specific immunotherapy. Diagnostic testing using whole-venom extracts with skin tests and serologic-based analyses remains the first level of discrimination for honeybee versus vespid venom sensitization in patients with a positive clinical history. As a second-level evaluation, serologic testing using molecular venom allergens can further discriminate genuine sensitization (honeybee venom: Api m 1, 3, 4, and 10 vs yellow jacket venom/Polistes dominula venom Ves v 1/Pol d 1 and Ves v 5/Pol d 5) from interspecies cross-reactivity (hyaluronidases [Api m 2, Ves v 2, and Pol d 2] and dipeptidyl peptidases IV [Api m 5, Ves v 3, and Pol d 3]). Clinical laboratories use a number of singleplex, oligoplex, and multiplex immunoassays that employ both extracted whole-venom and molecular venom allergens (highlighted earlier) for confirmation of allergic venom sensitization. Established quantitative singleplex autoanalyzers have general governmental regulatory clearance worldwide for venom-allergic patient testing with maximally achievable analytical sensitivity (0.1 kUA/L) and confirmed reproducibility (interassay coefficient of variation <10%). Emerging oligoplex and multiplex (fixed-panel) assays conserve on serum and are more cost-effective, but they need regulatory clearance in some countries and are prone to higher rates of detecting asymptomatic sensitization. Ultimately, the patient's clinical history, combined with proof of sensitization, is the final arbiter in the diagnosis of Hymenoptera venom allergy.
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Affiliation(s)
- Simon Blank
- Center of Allergy and Environment, Technical University of Munich, School of Medicine and Health and Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany.
| | - Peter Korošec
- Laboratory for Clinical Immunology and Molecular Genetics, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia; Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Benjamin O Slusarenko
- Center of Allergy and Environment, Technical University of Munich, School of Medicine and Health and Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg; Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis, Odense University Hospital, Odense, Denmark
| | - Robert G Hamilton
- Johns Hopkins University School of Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, Md.
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McMurray JC, Adams KE, Wanandy T, Le A, Heddle RJ. Stinging Ant Anaphylaxis: Advances in Diagnosis and Treatment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00745-1. [PMID: 39038538 DOI: 10.1016/j.jaip.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 06/27/2024] [Accepted: 07/07/2024] [Indexed: 07/24/2024]
Abstract
Stinging ants represent a wide range of over 200 different species across the world, of which Solenopsis, Myrmecia, Pogonomyrmex, and Brachyponera genera account for a substantial economic and healthcare burden. S. invicta (red imported fire ant [IFA]) and M. pilosula (jack jumper ant [JJA]) are 2 species of high clinical importance, known to cause anaphylaxis in humans, with numerous reported fatalities. Diagnostic testing should be performed in patients with a history of a systemic reaction with skin testing and/or in vitro specific immunoglobulin E (IgE) testing. In vitro testing is commercially available for IFA through whole-body extract specific IgE and JJA venom-specific IgE, but not widely available for other stinging ant species. Commercial venom component testing for IFA and JJA is currently not available. Patients with a clinical history and positive specific IgE testing should undergo treatment with specific immunotherapy, which is currently available for IFA and JJA. Buildup may be performed using conventional, semi-rush, rush, or ultra-rush schedules with similar risk profiles for IFA. Optimal duration for whole=body extract immunotherapy for IFA and specific JJA venom immunotherapy is not well studied, but generally recommended for at least 3 to 5 years. Sting challenges are used in research settings, primarily to assess treatment efficacy of immunotherapy.
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Affiliation(s)
- Jeremy C McMurray
- Allergy & Immunology Service, Walter Reed National Military Medical Center, Bethesda, Md.
| | - Karla E Adams
- Allergy & Immunology Service, Wilford Hall Ambulatory Surgical Center, San Antonio, Texas
| | - Troy Wanandy
- Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program, Royal Hobart Hospital, Hobart, Tasmania, Australia; College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia; National Allergy Centre of Excellence (NACE), Parkville, Victoria, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Adriana Le
- Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program, Royal Hobart Hospital, Hobart, Tasmania, Australia; College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia; National Allergy Centre of Excellence (NACE), Parkville, Victoria, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Robert J Heddle
- Department of Allergy and Immunology, University of Adelaide, Adelaide, South Australia, Australia
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Lopez DJ, Winkel KD, Wanandy T, van Nunen S, Perrett KP, Lowe AJ. The Human Health Impacts of the Red Imported Fire Ant in the Western Pacific Region Context: A Narrative Review. Trop Med Infect Dis 2024; 9:69. [PMID: 38668530 PMCID: PMC11053531 DOI: 10.3390/tropicalmed9040069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/29/2024] Open
Abstract
Background: The red imported fire ant (RIFA) is one of the world's most destructive invasive species. RIFA stings are painful and can lead to allergic reactions, including life-threatening anaphylaxis, yet health impacts remain inadequately defined. Methods: We searched MEDLINE (Ovid) and Google Scholar (grey literature) from inception until 20 September 2023 for articles in English using search terms related to red imported fire ants and allergies, including anaphylaxis. Results: Approximately a third of the population in RIFA-infested areas are stung each year. The most frequent reaction is a sterile 1-2 mm pseudo pustule on the skin. Approximately 20% of stings cause a large local reaction and between about 0.5% and 2% stings cause a systemic allergic reaction which can range from skin symptoms to life-threatening anaphylaxis. Local biodiversity is also significantly disrupted by invading RIFA and may lead to complex adverse effects on human health, from agriculture losses to expanded ranges for pathogen vectors. Conclusions: The potential for red imported fire ants to establish themselves as an invasive species in the Western Pacific presents a substantial and costly health issue. Successful eradication and surveillance programs, to identify and eradicate new incursions, would avoid substantial health impacts and costs.
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Affiliation(s)
- Diego J. Lopez
- Allergy and Lung Health Unit, The University of Melbourne, Melbourne, VIC 3053, Australia;
- National Allergy Centre of Excellence (NACE), Parkville, VIC 3052, Australia
| | - Kenneth D. Winkel
- National Allergy Centre of Excellence (NACE), Parkville, VIC 3052, Australia
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3053, Australia
| | - Troy Wanandy
- National Allergy Centre of Excellence (NACE), Parkville, VIC 3052, Australia
- Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program, Royal Hobart Hospital, Hobart, TAS 7000, Australia
- College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia
| | - Sheryl van Nunen
- National Allergy Centre of Excellence (NACE), Parkville, VIC 3052, Australia
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia
- Northern Beaches Hospital, Sydney, Sydney, NSW 2086, Australia
| | - Kirsten P. Perrett
- National Allergy Centre of Excellence (NACE), Parkville, VIC 3052, Australia
- Population Allergy Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
- Department of Allergy and Immunology, Royal Children’s Hospital Melbourne, Melbourne, VIC 3052, Australia
| | - Adrian J. Lowe
- Allergy and Lung Health Unit, The University of Melbourne, Melbourne, VIC 3053, Australia;
- National Allergy Centre of Excellence (NACE), Parkville, VIC 3052, Australia
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Wanandy T, Handley SA, Mulcahy E, Wiese M. Comparative study of the commonly used protein quantitation assays on different Hymenoptera venoms: A fundamental aspect of Hymenoptera venom proteome analysis. Toxicon 2024; 241:107685. [PMID: 38503352 DOI: 10.1016/j.toxicon.2024.107685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/08/2024] [Accepted: 03/09/2024] [Indexed: 03/21/2024]
Abstract
Determination of protein concentration in Hymenoptera venoms requires an accurate and reproducible assay as the results will be used to support subsequent proteomic techniques employed in their analyses. However, all protein assay techniques have inherent strengths and weaknesses, demanding their assessment before selecting the most suitable platform for sample analysis. In this study, protein profiles of ant, honeybee, and wasp venoms, and bovine serum albumin (BSA) and hyaluronidase standards were qualitatively assessed using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Their amino acid and protein concentration were quantitatively determined via Amino Acid Analysis (AAA). Amino acid concentration was determined via hydrolysis, derivatization, and chromatographic quantification. Protein concentration was estimated using four different protein concentration assays. The ratios of protein concentration in venom samples to protein standards were calculated, and the accuracy of the protein concentration assays was analysed relative to the concentration determined from AAA. SDS-PAGE analysis showed that BSA contained several protein bands, while hyaluronidase contained a mixture of peptide and protein bands. Ant and honeybee venoms contained a higher proportion of peptide bands, while wasp venom contained more protein bands. As determined by AAA, the ratio of protein concentration in Hymenoptera venoms varied between 1.01 and 1.11 to BSA, and between 0.96 and 1.06 to hyaluronidase. Overall, the Bradford assay was found to be the least accurate and the BCA assay was the most accurate in estimating protein concentration in Hymenoptera venoms. There was no significant advantage in using hyaluronidase as a standard or increasing incubation temperature of BCA assay when analysing Hymenoptera venoms. Diluent solutions containing phenol and human serum albumin interfered with Lowry-based assays.
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Affiliation(s)
- Troy Wanandy
- Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program, Royal Hobart Hospital, Hobart, Tasmania, Australia; College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.
| | - Simon A Handley
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia; Department of Pathology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Emily Mulcahy
- Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program, Royal Hobart Hospital, Hobart, Tasmania, Australia; College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Michael Wiese
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Alzeer RM, Al-Hadyan KS, Al-Harbi NM, Bin Judia SS, Almeer RS, Alsbeih GA. Cytotoxicity and Radiosensitizing Potentials of Pilosulin-3, a Recombinant Ant Venom, in Breast Cancer Cells. Toxins (Basel) 2023; 15:701. [PMID: 38133205 PMCID: PMC10747674 DOI: 10.3390/toxins15120701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
Venom peptides are promising agents in the development of unconventional anticancer therapeutic agents. This study explored the potential of Pilosulin-3, a recombinant peptide from the venom of the Australian jack jumper ant "Myrmecia pilosula", as a cytotoxic and radiosensitizing agent in MCF-7 and MDA-MB-231 breast cancer (BC) cell lines. Pilosulin-3's cytotoxicity was evaluated across a wide range of concentrations using a proliferation assay. Cell cycle progression and apoptosis were examined at the inhibitory concentration 25% (IC25) and IC50 of Pilosulin-3, both with and without a 4Gy X-ray irradiation dose. Radiosensitivity was assessed at IC25 using the clonogenic survival assay. The study revealed that Pilosulin-3 exerted a concentration-dependent cytotoxic effect, with IC25 and IC50 values of 0.01 and 0.5 µM, respectively. In silico screening indicated high selectivity of Pilosulin-3 peptide, which was predicted to be the most likely anticancer agent (PROB = 0.997) with low hemolytic activity (PROP = 0.176). Although Pilosulin-3 exhibited a significant (p < 0.05) G2/M cell cycle arrest in combination with radiation, there was no discernible effect on apoptosis induction or cell survival following irradiation. In conclusion, Pilosulin-3 proved to be cytotoxic to BC cells and induced a cytostatic effect (G2/M arrest) when combined with radiation. However, it did not enhance the efficacy of cell killing by irradiation. While it holds potential as a cytotoxic agent in breast cancer treatment, its application as a radiosensitizer does not find support in these results.
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Affiliation(s)
- Reema M. Alzeer
- Department of Zoology, College of Science, King Saud University, Riyadh 11541, Saudi Arabia
| | - Khaled S. Al-Hadyan
- Biomedical Physics Department, Radiation Biology Section, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Najla M. Al-Harbi
- Biomedical Physics Department, Radiation Biology Section, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Sara S. Bin Judia
- Biomedical Physics Department, Radiation Biology Section, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Rafa S. Almeer
- Department of Zoology, College of Science, King Saud University, Riyadh 11541, Saudi Arabia
| | - Ghazi A. Alsbeih
- Biomedical Physics Department, Radiation Biology Section, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
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Fernandes LGR, Spillner E, Jakob T. Potential and limitations of epitope mapping and molecular targeting in Hymenoptera venom allergy. FRONTIERS IN ALLERGY 2023; 4:1327391. [PMID: 38162556 PMCID: PMC10755883 DOI: 10.3389/falgy.2023.1327391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024] Open
Abstract
Hymenoptera venom (HV) allergy can lead to life threatening conditions by specific IgE (sIgE)-mediated anaphylactic reactions. The knowledge about major allergens from venom of different clinically relevant species increased in the last decades, allowing the development of component-resolved diagnostics in which sIgE to single allergens is analysed. Despite these advances, the precise regions of the allergens that bind to IgE are only known for few HV allergens. The detailed characterization of IgE epitopes may provide valuable information to improve immunodiagnostic tests and to develop new therapeutic strategies using allergen-derived peptides or other targeted approaches. Epitope-resolved analysis is challenging, since the identification of conformational epitopes present in many allergens demands complex technologies for molecular analyses. Furthermore, functional analysis of the epitopeś interaction with their respective ligands is needed to distinguish epitopes that can activate the allergic immune response, from those that are recognized by irrelevant antibodies or T cell receptors from non-effector cells. In this review, we focus on the use of mapping and molecular targeting approaches for characterization of the epitopes of the major venom allergens of clinically relevant Hymenoptera species. The screening of the most relevant allergen peptides by epitope mapping could be helpful for the development of molecules that target major and immunodominant epitopes blocking the allergen induced cellular reactions as novel approach for the treatment of HV allergy.
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Affiliation(s)
- Luís Gustavo Romani Fernandes
- Experimental Dermatology and Allergy Research Group, Department of Dermatology and Allergology, University Medical Center Gießen-Marburg, Justus Liebig University Gießen, Gießen, Germany
- Laboratory of Translational Immunology, Internal Medicine Department, School of Medical Sciences, State University of Campinas, Campinas-SP, Brazil
| | - Edzard Spillner
- Immunological Biotechnology, Department of Biological and Chemical Engineering, Aarhus University, Aarhus, Denmark
| | - Thilo Jakob
- Experimental Dermatology and Allergy Research Group, Department of Dermatology and Allergology, University Medical Center Gießen-Marburg, Justus Liebig University Gießen, Gießen, Germany
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Wanandy T, Le TTA, Lau WY, Wiese MD, Heddle RJ, Brown SGA. The development of Jack Jumper ant venom immunotherapy: our 25 years' experience. Intern Med J 2023; 53:1716-1721. [PMID: 37743244 DOI: 10.1111/imj.16217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/29/2023] [Indexed: 09/26/2023]
Abstract
Jack Jumper ant venom allergy is a uniquely Australian medical issue. The stinging ant is a leading cause of insect venom allergy in south-eastern Australia. An effective venom immunotherapy-based treatment was successfully developed by the Tasmanian Jack Jumper Allergy Research group. This paper provides a synopsis of our 25 years' research journey in developing this evidence-based treatment modality.
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Affiliation(s)
- Troy Wanandy
- Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program, Royal Hobart Hospital, Hobart, Tasmania, Australia
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Thanh-Thao A Le
- Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Wun Y Lau
- Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Michael D Wiese
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Robert J Heddle
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Simon G A Brown
- Division of Emergency Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia
- Aeromedical and Medical Retrieval Division, Ambulance Tasmania, Hobart, Tasmania, Australia
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Mo Y, Shi Q, Qi G, Chen K. Potential anti-tumor effects of Solenopsis invicta venom. Front Immunol 2023; 14:1200659. [PMID: 37283754 PMCID: PMC10239855 DOI: 10.3389/fimmu.2023.1200659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- Yizhang Mo
- Department of Spine Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qingxing Shi
- Guangdong Provincial Key Laboratory of High Technology for Plant Protection, Plant Protection Research Institute, Guangdong Academy of Agricultural Science, Guangzhou, Guangdong, China
| | - Guojun Qi
- Guangdong Provincial Key Laboratory of High Technology for Plant Protection, Plant Protection Research Institute, Guangdong Academy of Agricultural Science, Guangzhou, Guangdong, China
| | - Kebing Chen
- Department of Spine Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Chen SQ, Yang T, Lan LF, Chen XM, Huang DB, Zeng ZL, Ye XY, Wan CL, Li LN. Ant sting-induced whole-body pustules in an inebriated male: A case report. World J Clin Cases 2022; 10:6695-6701. [PMID: 35979310 PMCID: PMC9294895 DOI: 10.12998/wjcc.v10.i19.6695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/06/2022] [Accepted: 05/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many ant species can harm humans; however, only a few cause life-threatening allergic reactions. Normally, reactions caused by ants occur in patients who come into contact with ant venom. Venom contains various biologically active peptides and protein components, of which acids and alkaloids tend to cause anaphylaxis. Ant venom can cause both immediate and delayed reactions. The main histopathological changes observed in ant hypersensitivity are eosinophil recruitment and Th2 cytokine production.
CASE SUMMARY A 70-year-old man was bitten by a large number of ants when he was in a drunken stupor and was hospitalized at a local hospital. Five days later, because of severe symptoms, the patient was transferred to our hospital for treatment. Numerous pustules were observed interspersed throughout the body, with itching and pain reported. He had experienced fever, vomiting, hematochezia, mania, soliloquy, sleep disturbances, and elevated levels of myocardial enzymes since the onset of illness. The patient had a history of hypertension for more than 1 year, and his blood pressure was within the normal range after hypotensive drug treatment. He had no other relevant medical history. Based on the clinical history of an ant bite and its clinical manifestations, the patient was diagnosed with an ant venom allergy. The patient was treated with 60 mg methylprednisolone for 2 d, 40 mg methylprednisolone for 3 d, and 20 mg methylprednisolone for 2 d. Oral antihistamines and diazepam were administered for 12 d and 8 d, respectively. Cold compresses were used to treat the swelling during the process. After 12 d of treatment, most pustules became crusts, whereas some had faded away. No symptoms of pain, itching, or psychological disturbances were reported during the follow-up visits within 6 mo.
CONCLUSION This case report emphasizes the dangers of ant stings.
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Affiliation(s)
- Shi-Qi Chen
- Department of Dermatology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Tao Yang
- Department of Dermatology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Li-Fang Lan
- Department of Dermatology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Xiao-Ming Chen
- Department of Dermatology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Dong-Bei Huang
- Department of Dermatology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Zhao-Lin Zeng
- Department of Dermatology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Xiao-Ying Ye
- Department of Dermatology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Chun-Lei Wan
- Department of Dermatology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Long-Nian Li
- Department of Dermatology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
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