eMedicine Specialties > Emergency Medicine > Environmental

Fire Ant Bites: Follow-up

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

Follow-up

Inpatient & Outpatient Medications

  • Desensitization may be helpful to protect patients who are allergic from reactions to future stings. This type of immunotherapy has been used for almost 30 years to prevent the recurrence of anaphylaxis.
    • Treatment consists of weekly subcutaneous injections of increasing doses of whole-body vaccine until a predetermined maintenance dose is reached (usually 0.5 mL of a 1:10 dilution of the 1:10 weight/volume stock whole-body vaccine solution). Maintenance doses are typically administered every 4-6 weeks.
    • Immunotherapy for children with isolated skin reactions to fire ant stings is controversial because of a lack of data.2 Most allergists do not routinely recommend immunotherapy for this population, but some do because of the great risk of stings in endemic areas.
  • Prescribe an anaphylactic kit (ANA kit) or Epi-Pen, if indicated.2

Deterrence/Prevention

  • Avoidance of fire ants is important in the management of patients with fire ant hypersensitivity. Avoidance is facilitated by the following:
    • Having professionals evaluate the patient's home for stinging insect nests and fire ant mounds, and, if found, exterminating these nests and mounds
    • Not wearing brightly colored clothing or strongly scented lotions
    • Wearing shoes (not sandals) when walking outside
    • Being cautious around bushes, attics, picnic areas, or garbage containers
    • Keeping insecticides readily available
    • Wearing long pants, a long-sleeved shirt, socks, shoes, a hat, and work gloves when working outside
  • Attempts to control fire ant populations in endemic areas have included the use of chemical pesticides and novel biological control, including the use of decapitating flies. Decapitating flies (ie, Pseudacteon tricuspis, Pseudacteon curvatus, Pseudacteon littoralis) from South America have been released in the United States. These flies deposit an egg in the thorax of worker fire ants. The egg hatches and the larvae move toward the head, where they eat the ant's glands and muscles and release an enzyme that makes the ant's head fall off.3

Complications

  • Systemic allergic reactions are a potential complication of fire ant stings.
  • Secondary infection of the sting site with possible pyoderma or sepsis can occur.
  • Fatal toxic reactions from ant stings have been reported in small animals, but no human fatalities from toxic reactions have been reported.

    • Toxic reactions have been considered as possible factors in deaths occurring in immobilized, chronically ill subjects stung by fire ants, but toxicologic studies of fire ant venom effects in humans have not been performed.
    • It seems unlikely that the venom toxicity alone explains these deaths because patients who are not allergic have endured thousands of stings with no complications other than pustules.
  • Seizures and mononeuropathy are rare but have been reported.

Prognosis

  • Minor reactions have an excellent prognosis.
  • Severe reactions have an excellent prognosis with early and appropriate treatment.

Patient Education

  • Patient education is essential in preventing possible life-threatening reactions in patients who are allergic and in providing appropriate treatment of such reactions if they occur. This should include the following:

    • Identification of stinging insects
    • Knowledge of how to avoid being stung
    • Knowledge of how and when to self-administer epinephrine, if indicated
    • Carrying proper identification of stinging insect hypersensitivity (eg, Medic Alert bracelet)
  • For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education articles Insect Bites, Allergy: Insect Sting, and Severe Allergic Reaction (Anaphylactic Shock).

Miscellaneous

Medicolegal Pitfalls

  • Misdiagnosis as another pustular disorder is a pitfall. Very few pitfalls exist regarding fire ant bites and stings. Pustules potentially could be mistaken for an infectious process or a vesiculopustular skin disease. The patient might get aggressively evaluated with immunofluorescent biopsies or treated with antibiotics that may have complications, but this can be avoided by taking a careful history. Most patients give a history of exposure, but a few might not be aware of how they acquired these pustules.
  • Failure to recognize complications of overwhelming numbers of bites is a pitfall. Patients who develop systemic symptoms from numerous bites, or those who have allergic reactions, should be recognized early so that appropriate treatment can be given. Some patients may have a very rapidly changing clinical picture, so potential problems may not be immediately apparent.
 


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
[ CLOSE WINDOW ]

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].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

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

[ CLOSE WINDOW ]

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.

RELATED EMEDICINE ARTICLES
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.