What We Know About Sting-Related Deaths? Human Fatalities Caused by Hornet, Wasp and Bee Stings in Europe (1994-2016)

Epidemiology of Hymenopteran-related deaths in Europe due to bee, wasp and hornet stings (Cause Code of Death: X23) based on official registers from WHO Mortality Database is described. Over a 23-year period (1994-2016), a total of 1,691 fatalities were officially recorded, mostly occurring in Western (42.8%) and Eastern (31.9%) Europe. The victims tended to concentrate in: Germany (n=327; 1998-2015), France (n=211; 2000-2014) and Romania (n=149; 1999-2016). The majority of deaths occurred in males (78.1%), within the age group of 25-64 years (66.7%), and in an “unspecified place” (44.2%). The X23 gender ratio (X23GR) of mortality varied from a minimum of 1.4 for Norway to a maximum of 20 for Slovenia. The highest X23MR, expressed in terms of annual rates and per million inhabitants, were recorded in countries from Eastern Europe (0.35) followed by Western (0.28), Northern (0.23) and Southern Europe (0.2). The countries with the highest and lowest mean X23MR were Estonia (0.61), Austria (0.6) and Slovenia (0.55); and Ireland (0.05), United Kingdom (0.06) and the Netherlands (0.06), respectively. Country-by-country data show that the incidence of insect-sting mortality is statistically low, but not negligible.

Spontaneous Drainage of Lower Lip Abscess by Insect Sting in the Prediabetic Male: A Case Report

Most insects have a stinging apparatus at the tail end of their abdominal segment and can deliver venom. The venom can usually result in pain, erythema, abscess, or allergic reaction in human tissues such as the skin and even the lips. The presentation of lip abscess, especially in the vermilion, is rare and needs to be appropriately managed. A 39-year-old prediabetic male presented with a swollen right lower lip stung by an insect six days before the consult. The swelling started as a vesicle which became bigger, then burst, exuding a yellowish fluid and blood. The swollen area became more significant, and pain was felt. The clinical presentation was that of a lower lip abscess. Adequate antibiotics were prescribed along with a corticosteroid and a topical antiseptic. The treatment was essential to prevent the dissemination of infection and the likelihood of tissue necrosis. This case report is presented as a rare clinical case of a lower lip abscess due to an insect sting with spontaneous drainage after treatment in a prediabetic male. The dentist and clinician needed to identify this condition and to manage the case properly.

THE MANEUVER OF HOUSE HOLD HERBAL REMEDIES FOR HUMAN AILMENTS AND AGRICULTURAL PESTS

A steady search has been made to bring out the secrecy of herbal recipe preparations from the manuscript of various traditional medical practitioners who have been residing in the villages of Tirunelveli district, Tamil Nadu. The principal objective of the study is to document a sum of 21 plants belonging to 18 genera and 21 species widely used for human diseases such as antidote for Insect sting, Arteriosclerosis, Gastro intestinal disorders, Skin disorders, Migraine, Giddiness, Eczema, Tonsillitis, Foot crack and also as Insect repellent and Fungicide in agricultural fields. The potentiality of the herbal medicine is evaluated by observing the patients during and after the oral and external administration of herbal recipe by the rural healers. Cultivation, conservation and proper utilization of medicinal plant species are the need of hour to secure humans and agricultural crops from the adverse effects of broad spectrum of antibiotics and chemical pesticides. Further this study opens the way for making ecofriendly safe drugs and bio pesticides for mankind and cultivable plant species respectively.

Itch Beyond the Skin—Mucosal Itch

Itch is a nociceptive sensation linked with reflexes and cognitive motor actions. We traditionally think of itch as a sensation of the skin related to allergy, an insect sting or interestingly, anxiety and frustration. Less understood and considered are the physiological processes involved in the itching sensation that occurs at mucosal and junctional dermal sites, which is extraordinary as from an evolutionary point of view these sites serve important guardian roles, rich in sensory nerves and inflammatory cells. Despite itch being an ancient reflex and evolutionarily conserved phenomenon, better clinical understanding of the nuances between sites of itch sensation may lead to improved clinical outcomes. This review invites readers to appreciate itch beyond the skin by highlighting several specific itch patterns—nasal, oral, auricular, vulvovaginal, anal, and perineal itch—the pathophysiological mechanisms that underlie them, the clinical patterns these may cause, and some unique treatments.

Anaphylaxis: how to recognise and manage in primary care

Anaphylaxis is a life-threatening emergency. Hannah Kramer and Rebecca Batt explain how correct diagnosis, avoidance and patient education are fundamental in reducing risk Anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and can cause death. It is an immune-mediated reaction, which typically occurs when a person is exposed to a trigger, for example a food, drug, or insect sting. This article aims to assist with the recognition of symptoms and to guide management of anaphylaxis in primary care. Beyond the acute, the practice nurse can play a key role in helping patients to manage their allergies in the long-term, particularly for those who are most vulnerable. Patients should be supported in understanding how best to avoid their triggers, in managing their emergency medication, and in the importance of good asthma control.

Association between Venom Immunotherapy and Changes in Serum Protein—Peptide Patterns

Venom immunotherapy (VIT) is administered to allergic patients to reduce the risk of dangerous systemic reactions following an insect sting. To better understand the mechanism of this treatment and its impact on the human organism, we analysed serum proteomic patterns obtained at five time-points from Hymenoptera-venom-allergic patients undergoing VIT. For statistical analyses, patients were additionally divided into two groups (high responders and low responders) according to serum sIgG4 levels. VIT was found to be associated with changes in seven proteins: the fibrinogen alpha chain, complement C4-A, complement C3, filamin-B, kininogen-1, myosin-9 and inter-alpha-trypsin inhibitor heavy chain H1. The number of discriminative m/z (mass-to-charge ratio) features increased up to the 90th day of VIT, which may be associated with the development of immunity after the administration of increased venom doses. It may also suggest that during VIT, there may occur processes involved not only in protein synthesis but also in protein degradation (caused by proteolytic venom components). The results are consistent with measured serum sIgG4 levels, which increased from 2.04 mgA/I at baseline to 7.25 mgA/I at 90 days. Moreover, the major proteomic changes were detected separately in the high responder group. This may suggest that changes in protein–peptide profiles reflect the actual response to VIT.

Effects of a 90-min educational intervention for patients with insect venom allergy: a prospective controlled pilot study

Background Anaphylactic sting reactions need a prompt management. A structured educational intervention for patients with insect sting allergy has not been implemented so far. The purpose of this study was to analyze the effects of a structured 90-min educational intervention for patients with insect sting allergy. Methods Patients with an insect venom allergy were offered to participate in a structured 90-min group education (intervention group (IG)) or to attend a control group (CG). The patients’ subjective self-assurance in using the emergency medication, the willingness to always carry the emergency medication, the mental health status, absolute one-time willingness-to-pay (WTP) for complete cure, a disease knowledge assessment and a simulation test to examine the ability to manage an acute sting reaction were estimated at baseline (t0) and at follow-up (t1) as outcome parameters. Results 55 patients participated in the IG (n = 25, 52.0% female, mean age 55.9 years) or the CG (n = 30, 56.7% female, mean age 52.0 years). Both arms showed a significant gain in self-assurance in using the emergency medication (IG: 6.1 at t0 vs. 8.6 at t1, p < 0.0001 and CG: 7.1 vs. 8.0, p = 0.0062) and ability to manage an acute sting reaction (IG: 6.7 vs. 11.4, p < 0.0001 and CG: 9.0 vs. 10.5, p = 0.0002) at t1. However, trained participants showed a significantly higher gain in the respective parameters. There were no significant changes regarding the remaining examined outcome parameters. Conclusions Patients who are willing to invest 90 min in a patient education intervention benefit significantly by an increased subjective and objective empowerment to manage an acute sting reaction.

Nephrotic syndrome after insect sting: a case report

ABSTRACT Minimal change disease accounts for up to 25% of the cases of nephrotic syndrome in adult population. The allergic mechanism has been associated with minimal change disease and allergens have been implied, namely insect stings. We present a case report of a woman with new onset of nephrotic syndrome after a non-hymenoptera insect sting, with biopsy-proven minimal change disease, that was accompanied by a pulmonary thromboembolism process. Complete remission with glucocorticoid therapy was observed, with sustained response for 6 months after discontinuation. A new exposure to insect sting in the same geographical region and season triggered a nephrotic syndrome relapse. Subsequent avoidance of the place resulted in a sustained remission for more than 4 years.