Main Article Content
children, large local reaction, mosquito allergy, mosquito bite, unusual reaction
Background Many children encounter unusual or “exaggerated” reactions such as large local, atypical or systemic reactions after mosquito bites.
Objective The aim of this study was to document the clinical features of children with mosquito allergy and investigate the possible associations between demographic features and type of reactions in this population.
Methods Children with large local or unusual reactions after mosquito bites who attended to our outpatient pediatric allergy department were enrolled in the study along with control subjects.
Results A total of 180 children (94 with mosquito allergy and 86 age and sex-matched control subjects) with a median age of 6.8 years (IQR 5.5–9.3) were enrolled. Atopy (35.1% vs. 11.6%, p < 0.001) and grass pollen sensitization (28.7% vs. 8.1%, p < 0.001) were significantly more frequent in children with mosquito allergy. Skin prick test with mosquito allergen was positive in only 6 children (6,4%). Grass pollen sensitization was most common in children (28.7%) followed by sensitization to house dust mite (9.6%). 30 children (31.9%) had an accompanying atopic disease such as allergic rhinitis, asthma or atopic dermatitis. Bullae were significantly more frequent in children with asthma (41.7% vs.15.9, p = 0.034). The median duration of symptoms after onset were significantly longer in patients with ecchymosis, with immediate wheals and in children whose symptoms start in 20 min to 4 hours after mosquito bites.
Conclusion There is an association between unusual, large local or exaggerated reactions after mosquito bites and allergic diseases in children. The severity of reactions increases with age and particularly in children with atopic background.
2. Crisp HC, Johnson KS. Mosquito allergy. Ann Allergy Asthma Immunol. 2013;110(2):65–9. 10.1016/j.anai.2012.07.023
3. Peng Z, Simons FE. A prospective study of naturally acquired sensitization and subsequent desensitization to mosquito bites and concurrent antibody responses. J Allergy Clin Immunol. 1998;101(2 Pt 1):284–6. 10.1016/S0091-6749(98)70395-1
4. Peng Z, Rasic N, Liu Y, Simons FE. Mosquito saliva-specific IgE and IgG antibodies in 1059 blood donors. J Allergy Clin Immunol. 2002;110(5):816–7. 10.1067/mai.2002.128736
5. Peng Z, Estelle F, Simons R. Mosquito allergy and mosquito salivary allergens. Protein Pept Lett. 2007;14(10):975–81. 10.2174/092986607782541088
6. Global Initiative for Asthma. Global strategy for asthma management and prevention. 2020. Available from: https://www.ginasthma.org (Accessed March 12, 2020).
7. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63 Suppl 86:8–160. 10.1111/j.1398-9995.2007.01620.x
8. Eichenfield LF, Hanifin JM, Luger TA, Stevens SR, Pride HB. Consensus conference on pediatric atopic dermatitis. J Am Acad Dermatol. 2003;49(6):1088–95. 10.1016/S0190-9622(03)02539-8
9. Sahiner UM, Civelek E, Yavuz ST, Buyuktiryaki AB, Tuncer A, Sekerel BE. Skin prick testing to aeroallergen extracts: What is the optimal panel in children and adolescents in Turkey? Int Arch Allergy Immunol. 2012;157(4):391–8. 10.1159/000329870
10. Manuyakorn W, Itsaradisaikul S, Benjaponpitak S, Kamchaisatian W, Sasisakulporn C, Jotikasthira W, et al. Mosquito allergy in children: clinical features and limitation of commercially available diagnostic tests. Asian Pac J Allergy Immunol. 2017;35(4):186–90. 10.12932/AP0842
11. Kulthanan K, Wongkamchai S, Triwongwaranat D. Mosquito allergy: Clinical features and natural course. J Dermatol. 2010;37(12):1025–31. 10.1111/j.1346-8138.2010.00958.x
12. Tamay Z, Akcay A, Ergin A, Guler N. Prevalence of allergic rhinitis and risk factors in 6-to 7-year-old children in Istanbul, Turkey. Turk J Pediatr. 2014;56(1):31–40. 10.2332/allergolint.13-OA-0661
13. Bolat E, Arikoglu T, Sungur MA, Batmaz SB, Kuyucu S. Prevalence and risk factors for wheezing and allergic diseases in preschool children: A perspective from the Mediterranean coast of Turkey. Allergol Immunopathol (Madr). 2017;45(4):362–8. 10.1016/j.aller.2017.01.002
14. Scala E, Pirrotta L, Uasuf CG, Mistrello G, Amato S, Guerra EC, et al. Aedes communis reactivity is associated with bee venom hypersensitivity: An in vitro and in vivo Study. Int Arch Allergy Immunol. 2018;176(2):101–5. 10.1159/000488866
15. Bemanian MH, Korkinejad NA, Shirkhoda S, Nabavi M, Pourpak Z. Assessment of sensitization to insect aeroallergens among patients with allergic rhinitis in Yazd City, Iran. Iran J Allergy Asthma Immunol. 2012;11(3):253–8.
16. Cantillo JF, Puerta L, Lafosse-Marin S, Subiza JL, Caraballo L, Fernandez-Caldas E. Allergens involved in the cross-reactivity of Aedes aegypti with other arthropods. Ann Allergy Asthma Immunol. 2017;118(6):710–718. 10.1016/j.anai.2017.03.011
17. Gonzalez Diaz SN, Cruz AA, Sedo Mejia GA, Rojas Lozano AA, Valenzuela EA, Vidaurri Ojeda AC. [Prevalence of reactions secundary to mosquito bites Aedes aegypti at en el Regional Center of Allergy and Clinical Immunology, University Hospital, de Monterrey, Nuevo Leon]. Rev Alerg Mex. 2010;57(2):37–43.
18. Mellanby K. Man’s reaction to mosquito bites. Nature. 1946;158(4016):554. 10.1038/158554c0
19. McKiel JA, West AS. Nature and causation of insect bite reactions. Pediatr Clin N Am. 1961;8(3):795–816. 10.1016/S0031-3955(16)31157-9
20. Oka K, Ohtaki N. Clinical observations of mosquito bite reactions in man: A survey of the relationship between age and bite reaction. J Dermatol. 1989;16(3):212–9. 10.1111/j.1346-8138.1989.tb01251.x
21. Oka K, Ohtaki N, Igawa K, Yokozeki H. Study on the correlation between age and changes in mosquito bite response. J Dermatol. 2018;45(12):1471–4. 10.1111/1346-8138.14688
22. Walker GB, Harrison PV. Seasonal bullous eruption due to mosquitoes. Clin Exp Dermatol. 1985;10(2):127–32. 10.1111/j.1365-2230.1985.tb00540.x
23. Mai S, Mansouri S, Ismaili N, Senouci K. Impressive bullous reaction to mosquito bites. BMJ Case Rep. 2019;12(11): e232791. 10.1136/bcr-2019-232791
24. Penneys NS, Nayar JK, Bernstein H, Knight JW. Circulating antibody detection in human serum to mosquito salivary gland proteins by the avidin-biotin-peroxidase technique. J Am Acad Dermatol. 1988;181 Pt 187–92. 10.1016/S0190-9622(88)70013-4