Venom allergy and knowledge about anaphylaxis among beekeepers and their families

BACKGROUND: Beekeepers and their families are at an increased risk of life-threatening anaphylaxis due to recurrent bee-sting exposures. OBJECTIVE: The aim of this study is to evaluate the demographic features, previous history of anaphylaxis among beekeepers and their family members, and their knowledge about the symptoms and management of anaphylaxis. METHODS: A standardized questionnaire was administered to beekeepers during the 6th International Beekeeping and Pine Honey Congress held in 2018, in Mugla, Turkey. Additionally, food-service staff from restaurants were surveyed as an occupational control group about their knowledge about anaphylaxis. RESULTS: Sixty-nine beekeepers (82.6% male, mean age 48.4 ± 12.0 years) and 52 restaurant staff (46.2% male, mean age 40.5±10.0 years) completed the questionnaire. Awareness of the terms 'anaphylaxis' and 'epinephrine auto-injector' among the beekeepers were 55.1% and 30.4% and among the restaurant staff were 23.1% and 3.8%, respectively. Of the beekeepers, 74% were able to identify the potential symptoms of anaphylaxis among the given choices; 2.9% and 5.8% reported anaphylaxis related to bee-stings in themselves and in their family members, respectively. None of the restaurant staff had experienced or encountered anaphylaxis before but 3.8% of their family members had anaphylaxis and those reactions were induced by drugs. CONCLUSION: It is essential that implementation of focused training programs about anaphylaxis symptoms and signs as well as practical instructions of when and how to use an epinephrine auto-injector will decrease preventable morbidities and mortalities due to bee-stings in this selected high-risk population of beekeepers and their family members, as well as other fieldworkers under risk

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What's eating you? Megalopyge opercularis.

Caterpillars-the larval form of butterflies and moths-belong to the order Lepidoptera. Some identified caterpillars from this order have developed venomous defense mechanisms such as irritating hairs and spines to protect themselves from predators. Direct contact to allergenic caterpillars' hairs can cause human disease. Cutaneous lesions following caterpillar envenomation can range from mild localized inflammatory signs and pain to a worsening appearance of vesicles, bullae, erosions, petechiae, necrosis, and ulceration. This review addresses the varied general manifestations caused by venomous lepidopteran exposure with special focus on the adverse cutaneous manifestations and therapeutic options of Megalopyge opercularis, the caterpillar of the flannel moth.

Challenges of Remote Medical Care in South Sudan: Centipede Bites.

Centipede bites are a constant risk throughout tropical regions and have the rare potential for systemic side effects. We report a case of multiple centipede bites in South Sudan that was complicated by severe pain refractory to opioid analgesia and an unusual association with acute involuntary muscle contractions. Treatment with local anesthetic, antihistamines, and corticosteroids was effective. This report aims to add to the local literature; because of decades of internal conflict and poor infrastructure, reporting of health data from South Sudan is severely lacking. Further investigation into the pharmacological variation and activity of toxic peptides in centipede venom is recommended. As it stands, this case provides additional information on potential effects of centipede envenomation that should be useful to any healthcare providers preparing for the delivery of remote medical care throughout the Great Upper Nile region.

Centipede envenomation: Clinical importance and the underlying molecular mechanisms.

Centipede bites are usually characterized by mildly to moderately painful encounters with humans, however, they are relatively infrequent. The vast majority of centipede envenomations do not cause severe symptoms and only in very rare cases more serious symptoms such as myocardial ischemia and infarction, hematuria, hemoglobinuria, rhabdomyolysis, hemorrhage, pruritus, eosinophilic cellulitis, as well as anaphylaxis are observed. More prevalent are symptoms including pain, paresthesia, lethargy, localized necrosis, headache, dizziness and nausea. The numerous symptoms and complications elicited by these envenomations indicate that centipede venom possesses an arsenal of chemical components with functional diversity. Centipede venom is a rich and complex natural source of bioactive proteins, peptides and other small molecules that aid in predation or defense. The venom can induce myotoxic, cardiotoxic, neurotoxic and other toxic effects. The constituents target different cellular processes and pathways which in turn trigger a cascade of physiological reactions in the victim. The venom components are potent and selective on peripheral targets; thus, they are valuable in studying the molecular basis of these envenomation symptoms and complications. This review highlights the clinical importance of centipede envenomation and the recent discoveries on the underlying molecular mechanisms of the resulting symptoms which is crucial in therapy.

Hemostatic disorders induced by skin contact with Lonomia obliqua (Lepidoptera, Saturniidae) caterpillars.

Patients envenomed by Lonomia sp caterpillars initially experience a mild burning pain, headache, nausea, vomiting, and skin and mucosal hemorrhages. Some patients can rapidly progress to a severe coagulopathy that presents as visceral or intracerebral hemorrhaging. We studied the hemostatic alterations that occurred in 14 patients who were envenomed by Lonomia obliqua in Southern Brazil and presented at the Hospital São Vicente de Paulo (Passo Fundo, RS), Brazil during the summers of 1993 and 1994 when Lonomia antivenom was not yet available for treatment. The patients were classified into to 4 clinical groups: 0 (two patients), I (eight patients), II (two patients), and III (two patients). The patients were admitted to the hospital between 4 hours and five days after contact with the caterpillars. In this study, the coagulation parameters of the patients were followed up for up to 172 hours after the accidents. The patients received no treatment with the exceptions of two patients who received blood transfusions and antifibrinolytic treatment. The observed abnormalities related to blood coagulation and fibrinolytic factors were similar regardless of the severity of the bleeding symptoms. These findings suggest that alterations in hemostatic parameters without thrombocytopenia are not predictors of the seriousness of such accidents. Thus, consumptive disorder and reactive fibrinolysis are not proportional to mild coagulopathy. Furthermore, these patients recovered. The hemostatic parameters of most of the patients normalized between 96 and 120 h after the accident.

Hemostatic disorders induced by skin contact with Lonomia obliqua (Lepidoptera, Saturniidae) caterpillars

ABSTRACT Patients envenomed by Lonomia sp caterpillars initially experience a mild burning pain, headache, nausea, vomiting, and skin and mucosal hemorrhages. Some patients can rapidly progress to a severe coagulopathy that presents as visceral or intracerebral hemorrhaging. We studied the hemostatic alterations that occurred in 14 patients who were envenomed by Lonomia obliqua in Southern Brazil and presented at the Hospital São Vicente de Paulo (Passo Fundo, RS), Brazil during the summers of 1993 and 1994 when Lonomia antivenom was not yet available for treatment. The patients were classified into to 4 clinical groups: 0 (two patients), I (eight patients), II (two patients), and III (two patients). The patients were admitted to the hospital between 4 hours and five days after contact with the caterpillars. In this study, the coagulation parameters of the patients were followed up for up to 172 hours after the accidents. The patients received no treatment with the exceptions of two patients who received blood transfusions and antifibrinolytic treatment. The observed abnormalities related to blood coagulation and fibrinolytic factors were similar regardless of the severity of the bleeding symptoms. These findings suggest that alterations in hemostatic parameters without thrombocytopenia are not predictors of the seriousness of such accidents. Thus, consumptive disorder and reactive fibrinolysis are not proportional to mild coagulopathy. Furthermore, these patients recovered. The hemostatic parameters of most of the patients normalized between 96 and 120 h after the accident.

[Insect venom allergies : Update 2016 for otorhinolaryngologists]. / Insektengiftallergie : Update 2016 für HNO-Ärzte.

Due to the increasing incidence of hymenoptera venom allergies and the potentially life-threatening reactions, it is important for otolaryngologists working in allergology to have an understanding of modern diagnostic and treatment standards for this allergic disease. Molecular diagnosis with recombinant single allergens from bee and wasp venom components improves the diagnostics of insect venom allergies, particularly in patients with double-positive extract-based test results. Detection of specific sensitizations to bee or wasp venom enables double sensitizations to be better distinguished from cross-reactivity. Based on patient history and test results, the patient is initially advised on avoidance strategies and prescribed an emergency medication kit. Then, the indication for allergen-specific immunotherapy (AIT) is evaluated. The dose-increase phase can be performed using conventional, cluster, rush, or ultra-rush schedules, whereby rapid desensitization (rush AIT) performed in the clinic seems to be particularly effective as initial treatment.

Venomous and poisonous arthropods: identification, clinical manifestations of envenomation, and treatments used in human injuries.

This review presents the main species of venomous and poisonous arthropods, with commentary on the clinical manifestations provoked by the toxins and therapeutic measures used to treat human envenomations. The groups of arthopods discussed include the class Arachnida (spiders and scorpions, which are responsible for many injuries reported worldwide, including Brazil); the subphylum Myriapoda, with the classes Chilopoda and Diplopoda (centipedes and millipedes); and the subphylum Hexapoda, with the class Insecta and the orders Coleoptera (beetles), Hemiptera (stink bugs, giant water bugs, and cicadas), Hymenoptera (ants, wasps, and bees), and Lepidoptera (butterflies and moths).

Venomous and poisonous arthropods: identification, clinical manifestations of envenomation, and treatments used in human injuries

Abstract This review presents the main species of venomous and poisonous arthropods, with commentary on the clinical manifestations provoked by the toxins and therapeutic measures used to treat human envenomations. The groups of arthopods discussed include the class Arachnida (spiders and scorpions, which are responsible for many injuries reported worldwide, including Brazil); the subphylum Myriapoda, with the classes Chilopoda and Diplopoda (centipedes and millipedes); and the subphylum Hexapoda, with the class Insecta and the orders Coleoptera (beetles), Hemiptera (stink bugs, giant water bugs, and cicadas), Hymenoptera (ants, wasps, and bees), and Lepidoptera (butterflies and moths).

Lonomia obliqua Walker (Lepidoptera: Saturniidae): hemostasis implications.

In southern Brazil, since 1989, several cases of accidents produced by unwilling contact with the body of poisonous caterpillars of the moth species Lonomia obliqua Walker, 1855 (Lepidoptera: Saturniidae), were described. L. obliqua caterpillars have gregarious behavior and feed on leaves of host trees during the night, staying grouped in the trunk during the day, which favors the occurrence of accidents with the species. This caterpillar has the body covered with bristles that on contact with the skin of individuals, breaks and release their contents, inoculating the venom into the victim. The basic constitution of the venom is protein and its components produce physiological changes in the victim, which include disturbances in hemostasis. Hemorrhagic syndrome associated with consumption coagulopathy, intravascular hemolysis and acute renal failure are some of the possible clinical manifestations related to poisoning by L. obliqua. Specific laboratory tests for diagnosis of poisoning have not been described previously. The diagnosis of poisoning is made based on the patient's medical history, clinical manifestations, erythrocyte levels, and, primarily, parameters that evaluate blood coagulation. Treatment is performed with the use of supportive care and the administration of specific hyperimmune antivenom. Poisoning can be serious and even fatal.

Lonomia obliqua Walker (Lepidoptera: Saturniidae): hemostasis implications / Lonomia obliqua Walker (Lepidoptera: Saturniidae): implicações em hemostasia.

Summary In southern Brazil, since 1989, several cases of accidents produced by unwilling contact with the body of poisonous caterpillars of the moth species Lonomia obliqua Walker, 1855 (Lepidoptera: Saturniidae), were described. L. obliqua caterpillars have gregarious behavior and feed on leaves of host trees during the night, staying grouped in the trunk during the day, which favors the occurrence of accidents with the species. This caterpillar has the body covered with bristles that on contact with the skin of individuals, breaks and release their contents, inoculating the venom into the victim. The basic constitution of the venom is protein and its components produce physiological changes in the victim, which include disturbances in hemostasis. Hemorrhagic syndrome associated with consumption coagulopathy, intravascular hemolysis and acute renal failure are some of the possible clinical manifestations related to poisoning by L. obliqua. Specific laboratory tests for diagnosis of poisoning have not been described previously. The diagnosis of poisoning is made based on the patient's medical history, clinical manifestations, erythrocyte levels, and, primarily, parameters that evaluate blood coagulation. Treatment is performed with the use of supportive care and the administration of specific hyperimmune antivenom. Poisoning can be serious and even fatal.

Na região Sul do Brasil, a partir de 1989, foram descritos inúmeros casos de contato acidental com o corpo de lagartas venenosas da mariposa da espécie Lonomia obliqua Walker, 1855 (Lepidoptera: Saturniidae). As lagartas de L. obliqua possuem comportamento gregário e alimentam- -se de folhas das árvores hospedeiras durante a noite, permanecendo agrupadas no tronco durante o dia, o que favorece a ocorrência de acidentes. Essa lagarta possui o corpo recoberto por cerdas urticantes, que, ao contato com a pele dos indivíduos, se rompem e liberam seu conteúdo, inoculando o veneno na vítima. A constituição básica do veneno é proteica e seus componentes produzem modificações fisiológicas no acidentado, que incluem distúrbios na hemostasia. Síndrome hemorrágica associada a coagulopatia de consumo, hemólise intravascular e insuficiência renal aguda são algumas das manifestações clínicas possíveis relacionadas ao envenenamento por L. obliqua. Ainda não foram descritas avaliações laboratoriais específicas para diagnóstico do envenenamento, que é feito com base na anamnese do paciente, nas manifestações clínicas, nos índices hematimétricos e, principalmente, nos parâmetros que avaliam a coagulação sanguínea. A terapêutica é feita com a utilização de medidas de suporte e com a administração de um soro heterólogo hiperimune específico. Os envenenamentos podem ser graves e até mesmo fatais.

Cardiovascular collapse after myocardial infarction due to centipede bite.

Centipede bites have been reported to cause localized and/or systemic symptoms including local pain, erythema and edema, nausea and vomiting, palpitations, headache, lymphadenopathy, and rhabdomyolysis. However, acute myocardial infarction due to centipede envenomation is reported in only three cases in English medical literature.We present a case of 31-year-old male bitten by a golden colored centipede leading to myocardial infarction and cardiopulmonary arrest which is seen very rarely. The patient was admitted to emergency department with a swollen and painful right foot. However, typical chest pain became the major complaint and cardiopulmonary arrest developed while electrocardiography was being obtained. The patient was resuscitated successfully for 5 min and acute infero-posterolateral myocardial infarction was detected on electrocardiography.

"Sign of the kiss" in dermatitis caused by vesicant beetles ("potós" or Paederus sp.)

The cosmopolitan beetles of the Paederus genus (potós) cause a severe dermatitis when the insect is crushed against the skin of exposed areas (the cervical region is the most affected). Toxins (pederin and others) from the hemolymph of the insect cause plaques and/or bizarre, linear lesions with erythema, edema, blisters, pustules, crusts and exulcerations. There may be a burning sensation and severe conjunctivitis. Lesions disappear after 10 days and may leave hyperchromic macules. Treatment is made with topical corticosteroids and intensive washing.

"Sign of the kiss" in dermatitis caused by vesicant beetles ("potós" or Paederus sp.).

The cosmopolitan beetles of the Paederus genus (potós) cause a severe dermatitis when the insect is crushed against the skin of exposed areas (the cervical region is the most affected). Toxins (pederin and others) from the hemolymph of the insect cause plaques and/or bizarre, linear lesions with erythema, edema, blisters, pustules, crusts and exulcerations. There may be a burning sensation and severe conjunctivitis. Lesions disappear after 10 days and may leave hyperchromic macules. Treatment is made with topical corticosteroids and intensive washing.

[Feeding venomous insects among the people and the measures to curb and control this addiction by the government in the Song Dynasty].

Feeding venomous insects, a mystic witchcraft of producing poisonous materials to spoil other people has a long history which was still popular in the southern part of the Song Dynasty, aiming at revenge of one's enemy and the occupation of other's property. The Song government took a strict measures to tackle it, including enacting a decree to prohibiting it, encouraging people to report such malpractice, punishing heavily the person committing such criminal behavior and, at the same time, providing recipes and medicines to remedy its ensued disorders. All of these were helpful to the improvement of social morality.

[2013 update about arthropod envenomations in French Guyana]. / Le point en 2013 sur les envenimations liées aux arthropodes en Guyane française.

French Guiana, by its geographical situation, its climate and its biodiversity, is often called "the green hell". Indeed, this French department of America shelters a wildlife rich, abundant among which many species of arthropods, some of which are responsible for envenomations. These accidents consist of scorpion's or hymenoptera's stings or spider's bites. The associated clinical aspect is variable, from simple pain to circulatory collapse, or lung oedema. However, symptomatology is generally mild; four deaths associated to arthropod envenomations have been reported in the past 25 years. This article focuses on envenomations in French Guiana, describing favoring human behavior, risks and venoms associated with the main related animal species.

Anaphylaxis - identification, management and prevention.

OBJECTIVE: This article summarises current knowledge regarding the identification, management and prevention of anaphylaxis, highlighting risk minimisation strategies relevant to general practitioners. DISCUSSION: The most common causes of anaphylaxis are medication, food and insect venom. Medications are the most common cause of anaphylaxis in older adults, particularly antibiotics, anaesthetic drugs, nonsteroidal anti-inflammatory drugs and opiates. Food allergy is the most common cause of anaphylaxis in children, but rarely results in death. Anaphylaxis is a medical emergency requiring immediate treatment with adrenaline, as well as ongoing management. Important steps for long-term risk minimisation include avoidance of triggers, prescription of an adrenaline autoinjector, maintenance of a personalised emergency action plan for anaphylaxis, education for patients and families and regular review to optimise management.

Aspectos clínicos, epidemiológicos y de tratamiento de 11 casos de envenenamiento por ciempiés en Adícora, Península de Paraguaná, estado Falcón, Venezuela / Clinical, epidemiological and treatment aspects of eleven cases of centipede envenomation in Adícora, Paraguaná peninsula, Falcón state, Venezuela

A pesar de que las picaduras por ciempiés o centípedos (Phylum Arthropoda, Clase Chilopoda) son frecuentes y pueden potencialmente ocasionar el deceso del individuo, en Venezuela son pocos los estudios acerca de su ocurrencia. Entre octubre de 2006 y mayo de 2007, se realizó un estudio descriptivo y prospectivo para determinar los perfiles clínicos, epidemiológicos y tratamiento de los envenenamientos ocasionados por centípedos en individuos que asistieron a la emergencia ambulatoria en Adícora, estado Falcón, Venezuela. Se hizo la evaluación clínica y la anamnesis para indagar la hora y el lugar del accidente. El centípedo se recolectó para identificación. El tratamiento consistió en aplicación tópica de solución antiséptica yodada (Povidona®); analgésico antiinflamatorio endovenoso y toxoide tetánico; en el caso de abscesos se administró antibiótico terapia per os. Se registraron 11 pacientes mordidos por Scolopendra sp., 6 (54,55%) femeninos y 5 (45,46%) varones. Los accidentes ocurrieron con mayor frecuencia en meses de la estación seca (diciembre-abril; >60%), en adultos (39-62 años; 81,82%), residentes locales (81,82%) dentro del domicilio (54,55%) en horas nocturnas (63,64%) y en los miembros inferiores (54,55%). Los pacientes asistieron a la emergencia ambulatoria entre 5 a 600 minutos después del accidente ( =169,9 ± 236,3). Las manifestaciones clínicas mayormente observadas fueron de tipo local: dolor intenso [Escala Analógica Visual (VAS) = : 8,5 ± 0,63)], y eritema en 100% de los casos. Se obtuvo una evolución postratamiento satisfactoria entre 4 y 5 días y VAS de dolor promedio significativamente menor ( = 0,09± 0,20; t= 42,0, P= 0,0001). Los accidentes por Scolopendra sp. en Adícora, estado Falcón, Venezuela son un problema de salud pública, que parecieran incrementarse por los hábitos sinantrópicos y nocturnos de los centípedos, y seguir un patrón estacional. Se presentaron manifestaciones locales que requirieron un tratamiento básicamente local.

Despite centipede (Phylum Arthropoda, Clase Chilopoda) bites in humans are frequent and may potentially result in fatal consequences, in Venezuela publications on its envenoming and related characteristics are really scarce. Between October 2006 and May 2007, a descriptive and prospective survey was conducted to investigate epidemiological, clinical and treatment profiles on injuries caused by centipedes in patients that were attended in ambulatory emergency service at Adicora, Falcón state, Venezuela. These were clinically examined, and by mean of anamnesis were recorded site and time of bite. The centipede was collected for identification. Treatment consisted on the application of a topical antiseptic solution (povidone-iodine), intravenous administration of an anti-inflammatory analgesic, antibiotic therapy per os and tetanus immunization. It was registered 11 cases bitten by Scolopendra sp., 6 (54.55%) females and 5 (45.46%) males. Most of accidents occurred in the dry season (December- April>60%), adults (39-62 years old; 81.82%) local residents (81.82%), inside the home (54.55%), during the night (63.64%) and on the lower limbs (54.55%). The time between ambulatory medical assistance and the accident varied from 5 to 600 minutes, with a mean time of 169.9 ± 236.3. Most clinical manifestations observed were local: intense pain [Visual Analog Scale (VAS) = : 8.5 ± 0.63)], and erythema 100% of the cases. Patients had a satisfactory post-treatment evolution after 4 and 5 days, and pain VAS mean values significantly lower ( = 0.09 ± 0.20; t= 42.0, P= 0.0001). Envenoming injuries caused by Scolopendra sp. are public health concern at Adicora, Falcon state, Venezuela, that appear to increase with sinanthropic and nocturnal habits of centipede, and follow a seasonal pattern, requiring local symptomatic therapeutical treatment.