Decontamination Work and the Long-term Increase in Hospital Visits for Hymenoptera Stings Following the Fukushima Nuclear Disaster.

OBJECTIVE: Animals, including arthropods, are one health threat that can be affected by disasters. This institution-based study aimed to assess trends in Hymenoptera stings following the 2011 Fukushima nuclear disaster. METHODS: We reviewed the medical records of patients with hymenopteran stings who visited Minamisoma Municipal General Hospital, located 23 km from Fukushima Daiichi Nuclear Power Plant, from March 2005 to March 2016. Patient and sting characteristics of post-disaster patients were examined, and the annual incidence of hospital visits for hymenopteran stings was compared with the pre-disaster baseline, calculating an incidence rate ratio (IRR) for each year. RESULTS: We identified 152 pre-disaster patients (2005-2011) and 222 post-disaster patients (2011-2016). In the post-disaster period, 160 males (72.1%) were identified, with a median age of 59 years (range: 2-89 years). A total of 45 patients (20.3%) were decontamination workers. Post-disaster increases were found in the IRR for hymenopteran stings, peaking first in 2011 (IRR: 2.8; 95% confidence interval [CI]: 1.9-4.2) and later in 2014 (IRR: 3.2; 95% CI: 2.4-4.3) and 2015 (IRR 3.3; 95% CI: 2.5-4.4). CONCLUSIONS: Long-term increases were found in the IRR of hospital visits for hymenopteran stings in an institution affected by the Fukushima nuclear disaster. Decontamination workers appear to have been particularly affected by this phenomenon. Better disaster field worker monitoring and education about potential environmental health hazards may help to identify and prevent worker exposure to insect stings and other vectors in these settings. (Disaster Med Public Health Preparedness. 2017;11:545-551).

[Insect venom allergy ­ the diagnosis can be difficult to make but good treatment is available]. / Insektsgiftallergi - diagnostiken kan vara svår men bra behandling finns.

Bee and wasp stings can cause allergic reactions. Although the local reactions are more frequent, anaphylaxis due to insect stings can be potentially fatal. Rapid recognition of anaphylaxis is therefore critical and reactions should immediately be treated with i.m. adrenaline. Patients having experienced anaphylaxis should be referred to an allergist for diagnostic evaluation and possible venom-immunotherapy (VIT). The clinical history is essential in diagnosis of venom allergy as the test results are not always reliable. Diagnostic testing with venom components might be beneficial in appropriate patients. The analysis of serum tryptase from the acute episode can be crucial. Mastocytosis is associated in about 8 percent of patients with severe anaphylaxis from insect stings and should be considered in the differential diagnosis. VIT is indicated for patients with a history of anaphylaxis and is effective in preventing future anaphylaxis from Hymenoptera stings.

Chapter 4: Stinging insect allergy and venom immunotherapy.

The Hymenoptera order is divided into three families: Apids, Vespidae, and Formicidae. Apids include the honeybee, bumblebee, and sweat bee, which are all docile and tend to sting mostly on provocation. The Africanized killer bee, a product of interbreeding between the domestic and African honeybee, is very aggressive and is found mostly in Mexico, Central America, Arizona, and California. The yellow jacket, yellow hornet, white (bald)-faced hornet, and paper wasp all belong to the Vespidae family. The Formicidae family includes the harvester ant and the fire ant. When a "bee" sting results in a large local reaction, defined as >5 in. and lasting >24 hours, the likelihood of anaphylaxis from a future sting is ∼5%. For comparison, when there is a history of anaphylaxis from a previous Hymenoptera sting and the patient has positive skin tests to venom, at least 60% of adults and 20-32% of children will develop anaphylaxis with a future sting. Both patient groups should be instructed about avoidance measures and carrying and knowing when to self-inject epinephrine, but immunotherapy (IT) with Hymenoptera venom is indicated for those patients with a history of anaphylaxis from the index sting and not for patients who have experienced a large local reaction. IT is highly effective in that by 4 years of injections, the incidence of subsequent sting-induced anaphylactic reactions is 3%. This incidence may increase modestly after discontinuation of injections but has not been reported >10% in follow-up.

[A complex of blood-sucking mosquitoes (Diptera, Culicidae) in the focus of West Nile fever in the Volgograd Region. III. Species feeding on birds and man and the rhythms of their nocturnal activity].

The rate and nocturnal rhythm of mosquito attacks of birds and human beings were studied in the open biotopes of Volgograd and its vicinity in 2004. Thirteen and 11 species of the subfamily Culicinae were collected under the Berezantsev bell and from the traps containing a chicken (a hen), respectively; of them 9 species were common. The mosquitoes of an Anopheles maculipennis complex were caught in a small portion to the traps of both types. Most species of Aedes were highly anthropophilic, showed the minimum activity at night and their abundance considerably decreased by the early transmission period. Among the species that were active during the transmission period, Ae. vexans, Coq. richiardii, and Cx. modestus more intensively attacked a human being than birds and Cx. pipiens was frequently attracted into the hen traps. The attraction of each species of the caught varied during the transmission period. The maximum attacks of Cx. modestus and Cx. pipiens on man and birds coincide and those of Coq. Richiardii and Cx. pipiens on man was observed earlier than on birds. A possible role of mosquitoes of different species in the epizootic and epidemiological processes is discussed.

Papular urticaria and things that bite in the night.

Whether we are hiking in the back country or playing in our backyard, we run the risk of exposure to offending arthropods. Papular urticaria is a very common hypersensitivity reaction to the bites, stings, and contact with critters such as mites, ticks, spiders, fleas, mosquitoes, midges, flies, and even caterpillars. Children seem to be at greatest risk, although adults are also vulnerable. The classic presentation of papular urticaria includes recurrent pruritic papules or vesicles and varying degrees of local edema. Severity is often related to the host response to the salivary or contactant proteins. Our understanding of the immune mechanism continues to improve; however, our approach to therapy has remained essentially unchanged. Although this review admittedly reaches beyond papular urticaria, it is with the intention of improving the reader's recognition of the offending arthropods, the characteristics of reactions, and the current therapeutic approaches.

Subsequent insect stings in children with hypersensitivity to Hymenoptera.

To investigate the risk of life-threatening reactions to future stings, we sequentially challenged 113 children (aged 2 to 17 years) allergic to insect stings with a sting by the relevant insect. The time interval between the challenges varied from 2 to 6 weeks. The history of the index stings was a large local reaction (LR) in 16% and a systemic reaction (SR) in 84% of the test subjects. On the first challenge, 76% had a normal LR, 11% a large LR, and 13% an SR. On the second challenge, 78% of the children had a normal LR, 5% a large LR, and 17% an SR. Thirty-nine of the untreated children were exposed to a field sting during the subsequent 3-year follow-up period. In comparison with other diagnostic evaluations such as skin-prick tests, determinations of specific IgE and IgG antibodies, and single-sting exposure, the dual sting challenge scheme appears to be the best predictor of reactions to subsequent stings. It also appears to be helpful in selecting patients with an uncertain sensitization status for venom immunotherapy.