Modification of footed pajamas to confirm arthropod bites: The Modified Onesie Biting Bug Assessment suit.

When children present with features of bed bug bites, many parents are reluctant to accept the diagnosis. Furthermore, standard methods to detect arthropods in or around one's home can be expensive, time-consuming, and frustrating. We developed a simple, inexpensive way to provide evidence that the lesions are in fact due to arthropod bites. The Modified Onesie Biting Bug Assessment (MOBBA) suit utilizes simple alterations to a full-body onesie-type footed pajama, exposing some body surfaces to insect predators while protecting other areas.

Comparison of cellular and humoral immunoassays for the assessment of summer eczema in horses.

The objective of this study was to compare and analyze three common diagnostic methods for summer eczema (SE) in horses, an allergic dermatitis caused by bites of Culicoides spp. Nine horses with a medical history of SE and nine control animals were intradermally challenged with whole body extracts (WBE) and the saliva of a native (C. nubeculosus) and exotic (C. sonorensis) Culicoides species. Blood and serum samples of the horses were examined for basophil reactivity by a histamine release test (HRT) and for Culicoides-specific serum immunoglobulin E (IgE) and G (IgG) by enzyme-linked immunosorbent assay (ELISA). The results of intradermal testing (IDT) at 30min (immediate reactivity) and 4h (late-phase reactivity) post challenge with most insect preparations revealed significant differences between horses with and without SE. Overall, the HRT showed the most accurate results with a sensitivity of 1.00 for all Culicoides preparations and specificities of 0.78 (WBE) and 1.00 (saliva). By contrast, delayed reactions of the IDT (24h), and levels of Culicoides-specific IgE and IgG in the native serum showed little or no distinction between allergic and non-allergic horses. However, the use of purified serum IgE and IgG indicated the possibility for elevated titers of insect-specific serum immunoglobulins in horses with SE. The IDT and HRT did not reveal obvious differences in onset and intensity of positive reactions for the native verses exotic Culicoides species, whereas the ELISA showed slightly higher numbers of positive reactions for serum IgG with the indigenous species. Saliva, as compared to WBE, was found to have improved sensitivity and/or specificity for the HRT and for the late-phase immune reactions as measured by the IDT. Overall, the results indicate that allergy tests utilizing effector cells (mast cells, basophils) are more accurate in diagnosing SE in horses than serological analysis by ELISA.

Skin testing technique and precision in stinging insect allergy.

AIM: We report on quantitative analysis of skin tests in patients undergoing Hymenoptera venom immunotherapy. The need for accuracy, coupled with a sound manual technique, in performing this procedure is emphasized. Involuntary errors may occur and pose serious problems with interpretation of results. A revealing example is reported and the strategy devised to analyse the flaws and overcome the resulting problems is presented and discussed. BACKGROUND: Skin testing plays a key role in the diagnosis of most allergic disease and in the assessment of allergen immunotherapy. Particularly, insect sting allergy requires implementation of complex and demanding skin testing protocols and a competent nursing practice. METHODS: Sixteen patients were tested before starting the immunotherapy and after three years of treatment. Cutaneous response (expected to decline, following immunotherapy) was assessed as: (i) allergen-elicited wheal areas; (ii) ratios between allergen-elicited wheal areas and homologous histamine (positive controls) wheal areas. RESULTS: By using allergen-elicited areas, the paradoxical result was obtained that skin reactivity had increased instead of decreasing, upon immunotherapy. Histamine response analysis suggested that this paradox might rather be the result of a technical flaw. Analysis of written notes of routine clinical meetings revealed that an important manual flaw had been detected (and corrected) some years earlier, affecting the results of the baseline testing (viz. the allergen was injected deeper in the skin, yielding a weaker response). Skin reactivity evaluation in terms of allergen-histamine ratio confirmed this interpretation, as, when the baseline ratios were compared with the three years immunotherapy ratios, a distinct decline in skin reactivity was detected, as expected. CONCLUSIONS: Skin testing in insect sting allergy is a conceptually and manually complex procedure, which should be subjected to systematic quality control assessment, like a laboratory procedure. The personnel involved in the performance of this procedure should receive appropriate and extensive training. RELEVANCE TO CLINICAL PRACTICE: Diagnosis of allergic diseases and monitoring of immunotherapy largely rely on impeccable skin testing technique.

Assessment and initial treatment of lacerations, mammalian bites, and insect stings.

Millions of wounds are seen in emergency rooms across the United States each year. The goals of wound care for all ages are to avoid infection and achieve an esthetically pleasing and functional scar. This article reviews the care needs associated with acute traumatic wounds. Information presented includes anatomy and physiology of skin and wound healing, and assessment and care of lacerations, bites, and sting wounds.