Grote lokale reactie bij huidziekten

INTRODUCTION

Allergic reactions triggered by Hymenoptera insects have been described as long ago as 2000 B.C. 1 It was not until the early part of the 20th century that the first medical reference was made for the treatment of allergic reactions to Hymenoptera. 2 Over the last 100 years, the knowledge base for the diagnosis and treatment of stinging insect allergy has greatly expanded.

Reactions following stings by Hymenoptera insects, primarily honeybee, wasp, yellowjacket, hornet and ant, are common. While most sting reactions are localized and self-limited, some lead to large local reactions or to systemic allergic reactions or anaphylaxis and cause death. Prompt recognition, diagnosis, and treatment of these systemic allergic reactions is important to improve the quality-of-life of such individuals and reduce the risk for future sting reactions.

This review summarizes the current recommendations to diagnose and treat Hymenoptera sting induced allergic reactions and highlights considerations for various populations throughout the world.

What to Do for a Wasp Sting

Wasp stings are common, especially during the warmer months when people are outside for longer periods.

Wasps, like bees and hornets, are equipped with a stinger for self-defense. A wasp’s stinger contains venom (a poisonous substance) that’s transmitted to humans during a sting.

However, even without a lodged stinger, wasp venom can cause significant pain and irritation. It’s also possible to have a serious reaction if you’re allergic to the venom. In either case, prompt treatment is important for alleviating symptoms and complications.

The majority of people without sting allergies will show only minor symptoms during and after a wasp sting. The initial sensations can include:

• sharp pain
• burning at the sting site
• discoloration
• swelling
• itching

DIAGNOSIS

Skin testing for suspected IFA allergy (S. invicta and S. richteri) should be considered in subjects with a history of a systemic reaction following an IFA sting. IFA are native to South America but are now endemic in the southeastern United States, Australia, Taiwan, Philippines, and China. IFA stings are common in these areas thus there is a high incidence of "false positive" skin sensitivity. 27 , 28 As with other Hymenoptera species, skin prick testing is performed first followed by the appropriate intradermal testing, as necessary. The initial concentration for IFA intradermal testing is 1:1 million (1×10 6 ) weight/volume (w/v) of whole body extract (WBE). If these tests are negative, the concentration should be increased 10-fold until a positive response is reached or to a maximum concentration of 1:1,000 or 1:500 w/v. In Asia and Australia, several other ant species are important causes of venom-induced anaphylaxis. In Australia, stings by the jack jumper ant (Myrmecia pilosula) and bull ant (Myrmecia pyriformis) are common, while in Korea and other parts of Southeast Asia, Pachycondyla species are relevant. Skin prick puncture and intradermal tests using WBE (Pachycondyla) or venom extracts (Myrmecia) are recommended to confirm suspected IgE-mediated allergy to these ant species. Intradermal concentrations of 1 µg/mL or less have been used successfully to help diagnose allergy to the jack jumper ant (Myrmecia pilosula), but less is known about other ant species. 29 Extracts for skin testing to these ant species are not commercially available.

Component-resolved diagnosis (CRD) involves the identification of IgE antibodies to specific components rather than the whole allergen. In food allergies, CRD may become important to identify subjects at risk for future serious allergic reactions to a food versus those that may have elevated specific IgE to a food due to cross-reactivity, e.g. peanut and birch pollen. 32 CRD may also be useful in subjects with Hymenoptera allergy. Many Hymenoptera allergic subjects have cross-reactivity between bee and wasp venoms with standard skin and IgE testing, which may be due to cross-reactive carbohydrate determining reagents rather than true cross-reactivity between venom proteins. Determination of specific IgE to Api m 1 (phospholipase A2) and Ves v 5 (antigen 5), rather than to conventional venom extracts, could be useful to determine if cross-reactivity is present to both venoms, especially if the clinical history is uncertain. This could aid in the selection of venoms used for immunotherapy. 33 , 34 To date, only a few venom components are fully sequenced, including Api m 1, Ves v 1, and Ves v 5.

Stekende bijen, hommels en wespen

Vooral bekend door hun steken zijn de sociaal levende bijen, hommels en wespen. Hun angel is verbonden met een gifzakje dat bij het steken samentrekt en zo gif in de huid spuit. Dit gif bevat verschillende eiwitten, die pijn, zwelling en jeuk kunnen veroorzaken maar ook forse allergische reacties.

In Nederland worden we van deze drie het meest gestoken door wespen, meestal rond eind augustus wanneer de wespennesten de maximale omvang bereikt hebben. De taak voor de werksters zit erop en ze trekken de wijde wespenwereld in. Deze volwassen wespen leven vooral van zoetigheid, laten zich niet gauw hun eten afnemen en prikken snel.

De bruinzwart gekleurde honingbij steekt meestal pas als zij gestoord wordt bij het zoeken naar voedsel, of wanneer iemand te dicht bij de kolonie komt. De meer harige en bollere hommel steekt in de vrije natuur vrijwel niet, tenzij iemand erbovenop gaat staan of zitten. Wel worden vaak allergische reacties gezien bij kwekers die gebruik maken van hommels voor het bestuiven van tomaten en paprikabloemen.

Mild to moderate reactions

You can treat mild and moderate reactions to wasp stings at home. While treating your sting at home, you should:

• wash the sting area with soap and water to remove as much of the venom as possible
• apply a cold pack to the wound site to reduce swelling and pain
• keep the wound clean and dry to prevent infection
• cover with a bandage if desired

The following home remedies can also help:

• hydrocortisone cream or calamine lotion, if itching or skin irritation becomes bothersome
• baking soda and colloidal oatmeal used during a bath or in the form of medicated skin creams, to help soothe the skin
• OTC pain relievers, such as ibuprofen, to help manage pain associated with wasp stings.
• antihistamine drugs, including diphenhydramine and chlorpheniramine, to reduce itching.