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Fire Ant Bites: Differential Diagnoses & Workup

Author: James P Ralston, MD, President, Dermatology Center of McKinney
Coauthor(s): Ronald P Rapini, MD, Josey Professor and Chair, Department of Dermatology, Professor of Pathology, University of Texas Medical School at Houston and MD Anderson Cancer Center
Contributor Information and Disclosures

Updated: Nov 10, 2009

Differential Diagnoses

Acneiform Eruptions
Folliculitis
Acropustulosis of Infancy
Herpes Simplex
Bedbug Bites
Herpes Zoster
Black Widow Spider Bite
Insect Bites
Brown Recluse Spider Bite
Linear IgA Dermatosis
Bullous Disease of Diabetes
Psoriasis, Pustular
Candidiasis, Cutaneous
Seabather's Eruption
Cellulitis
Subcorneal Pustular Dermatosis
Chickenpox
Transient Neonatal Pustular Melanosis
Cutaneous Larva Migrans
Urticaria, Cholinergic
Drug-Induced Bullous Disorders
Eosinophilic Pustular Folliculitis
Erythema Toxicum Neonatorum

Other Problems to Be Considered

Local reaction (infection, punctures, foreign bodies, various other dermatoses)
Toxic reaction (chemical exposure/ingestion, intravenous drug abuse, environmental, plants)
Allergic reaction (medications, illicit drugs, foods, topical products, environmental, plants, chemicals)

Workup

Laboratory Studies

  • Laboratory studies are not necessary for most people with fire ant stings; however, in severe reactions, a CBC count, coagulation studies, and a urinalysis could be obtained for the following uncommon but possible manifestations:

Other Tests

  • Skin testing, enzyme-linked immunosorbent assay (ELISA), and radioallergosorbent testing (RAST) can be used to confirm a clinical history of fire ant hypersensitivity.
    • A venom ELISA assay has demonstrated equivalent sensitivity to venom RAST and is less expensive.
    • Reagents containing venom proteins are required for these tests. Because pure venom vaccines are not commercially available, whole-body extracts are used.
    • Patients without a clinical history of allergic reactions to fire ants should not be tested because of the high degree of asymptomatic IgE production in an exposed population.

Histologic Findings

The histologic findings depend on the stage of evolution of the lesion. In early lesions, a perivascular infiltrate of lymphocytes, neutrophils, and eosinophils is found within the dermis. Later, an intraepidermal vesicle or pustule (containing mostly neutrophils) is usually present, often with a central focus of epidermal necrosis. Dermal edema is often present. Compared with other arthropod assaults, fire ant stings are far more pustular, with more neutrophils and fewer eosinophils.

More on Fire Ant Bites

Overview: Fire Ant Bites
Differential Diagnoses & Workup: Fire Ant Bites
Treatment & Medication: Fire Ant Bites
Follow-up: Fire Ant Bites
Multimedia: Fire Ant Bites
References
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References

  1. More DR, Kohlmeier RE, Hoffman DR. Fatal anaphylaxis to indoor native fire ant stings in an infant. Am J Forensic Med Pathol. Mar 2008;29(1):62-3. [Medline].

  2. [Guideline] Moffitt JE, Golden DB, Reisman RE, Lee R, Nicklas R, Freeman T, et al. Stinging insect hypersensitivity: a practice parameter update. J Allergy Clin Immunol. Oct 2004;114(4):869-86. [Medline]. [Full Text].

  3. Williams DF, deShazo RD. Biological control of fire ants: an update on new techniques. Ann Allergy Asthma Immunol. Jul 2004;93(1):15-22. [Medline].

  4. Burroughs R, Elston DM. What's eating you? Fire ants. Cutis. Feb 2005;75(2):85-9. [Medline].

  5. Champion RH, Burton JL, Burns DA. Rook/Wilkinson/Ebling Textbook of Dermatology. Vol 2. 6th ed. London, England: Blackwell Science; 1998:1436-7.

  6. Cotran RS, Kumar V, Collins T, eds. Robbins Pathologic Basis of Disease. 6th ed. Philadelphia, Pa: WB Saunders; 1999:1212.

  7. Dambro MR, Griffith JA. Griffith's 5-Minute Clinical Consult. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999:570-1.

  8. Ellis AK, Day JH. Clinical reactivity to insect stings. Curr Opin Allergy Clin Immunol. Aug 2005;5(4):349-54. [Medline].

  9. Ford JL, Dolen WK, Feger TA, Hoffman DR, Stafford CT. Evaluation of an in vitro assay for fire ant venom-specific IgE. J Allergy Clin Immunol. Sep 1997;100(3):425-7. [Medline].

  10. Freedberg IM, Eisen AZ, Wolff K, eds. Fitzpatrick's Dermatology in General Medicine. Vol 2. 5th ed. New York, NY: McGraw-Hill; 1999:2693-5.

  11. Goddard J, Jarratt J, de Castro FR. Evolution of the fire ant lesion. JAMA. Nov 1 2000;284(17):2162-3. [Medline].

  12. Hoffman DR. Reactions to less common species of fire ants. J Allergy Clin Immunol. Nov 1997;100(5):679-83. [Medline].

  13. Jerrard DA. ED management of insect stings. Am J Emerg Med. Jul 1996;14(4):429-33. [Medline].

  14. Kemp SF, deShazo RD, Moffitt JE, Williams DF, Buhner WA. Expanding habitat of the imported fire ant (Solenopsis invicta): a public health concern. J Allergy Clin Immunol. Apr 2000;105(4):683-91. [Medline].

  15. Lee TH, Comes S, Burgos T. ePocrates qRx. ePocrates Inc. Available at http://www.epocrates.com/. Accessed 2000.

  16. Odom RB, James WD, Berger TG. Andrews' Diseases of the Skin: Clinical Dermatology. 9th ed. Philadelphia, Pa: WB Saunders; 2000:559.

  17. Ownby DR. Pediatric anaphylaxis, insect stings, and bites. Immunol Allergy Clin North Am. 1999;19 (2):347-61.

  18. Rakel RE. Conn's Current Therapy 2000. 52nd ed. Philadelphia, Pa: WB Saunders; 2000:753-5.

  19. Smith KE, Fenske NA. Cutaneous manifestations of alcohol abuse. J Am Acad Dermatol. Jul 2000;43(1 Pt 1):1-16; quiz 16-8. [Medline].

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Further Reading

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Keywords

fire ant bites, imported fire ants, fire ant bite treatment, fire ant bite symptoms, Solenopsis invicta, S invicta, , , , , , , , , Hymenoptera, hypersensitivity reactions, Soli 1-4, anaphylaxis, anaphylactic reaction, fire ant-induced anaphylaxis

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Contributor Information and Disclosures

Author

James P Ralston, MD, President, Dermatology Center of McKinney
James P Ralston, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Ronald P Rapini, MD, Josey Professor and Chair, Department of Dermatology, Professor of Pathology, University of Texas Medical School at Houston and MD Anderson Cancer Center
Ronald P Rapini, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Society for Investigative Dermatology, Southern Medical Association, and Texas Medical Association
Disclosure: Elsevier publishers Royalty Independent contractor

Medical Editor

Daniel J Hogan, MD, Clinical Professor of Internal Medicine (Dermatology), NOVA Southeastern University; Investigator, Hill Top Research, Florida Research Center
Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey J Miller, MD, Associate Professor of Dermatology, Penn State University College of Medicine; Staff Dermatologist, Penn State Milton S Hershey Medical Center
Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

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