Fire Ant Bites Treatment & Management

Author: James P Ralston, MD; Chief Editor: Rick Kulkarni, MD more...

Updated: Jan 23, 2012

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Medical Care
Consultations
Diet
Activity
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References

Medical Care

Local stings: Cool compresses and oral antihistamines are recommended for mild reactions. Corticosteroids can be used topically or intralesionally for anti-inflammatory effect.
Multiple stings: Systemic corticosteroid use is controversial in patients with extensive lesions who do not have systemic allergic reactions or generalized skin reactions.
- Large doses of corticosteroids and intravenous fluids may complicate the treatment of patients with preexisting cardiovascular disease.
- The immunosuppressive effect of corticosteroids may predispose patients to secondary infection.
- Oral antihistamines and topical corticosteroids are recommended in most cases; nevertheless, some practitioners still use prednisone or other systemic steroids to treat patients with numerous lesions.
Anaphylaxis: Acute management of fire ant anaphylaxis is identical to treatment of anaphylaxis from other causes. Subcutaneous epinephrine is used and repeated every 10-15 minutes as needed to reverse the symptoms.

Consultations

An allergist/immunologist consultation for evaluation and possible skin or in vitro testing for fire ant hypersensitivity is appropriate for any patient who has a systemic reaction to a fire ant sting. Consultation should be considered if the patient meets 1 of the following criteria:

Experiences anaphylaxis with a fire ant sting as a possible cause
Needs education regarding fire ant avoidance or emergency treatment
May need venom immunotherapy
Has a coexisting condition that may complicate treatment of anaphylaxis (eg, using beta-blockers, having hypertension or cardiac arrhythmias)

Diet

No dietary changes are recommended; however, patients should have nothing by mouth if experiencing a severe systemic reaction.

Activity

No restriction in activity is required; however, rest is recommended in severe cases to possibly slow the spread of the reaction.

Proceed to Medication

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, and Texas Medical Association

Disclosure: Elsevier publishers Royalty Independent contractor

Specialty Editor Board

Daniel J Hogan, MD Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; 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.

Michael J Wells, MD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

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.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania 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.

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 Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Rick Kulkarni, MD Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

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[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].
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].
Burroughs R, Elston DM. What's eating you? Fire ants. Cutis. Feb 2005;75(2):85-9. [Medline].
Champion RH, Burton JL, Burns DA. Rook/Wilkinson/Ebling Textbook of Dermatology. Vol 2. 6^th ed. London, England: Blackwell Science; 1998:1436-7.
Cotran RS, Kumar V, Collins T, eds. Robbins Pathologic Basis of Disease. 6^th ed. Philadelphia, Pa: WB Saunders; 1999:1212.
Dambro MR, Griffith JA. Griffith's 5-Minute Clinical Consult. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999:570-1.
Ellis AK, Day JH. Clinical reactivity to insect stings. Curr Opin Allergy Clin Immunol. Aug 2005;5(4):349-54. [Medline].
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].
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Goddard J, Jarratt J, de Castro FR. Evolution of the fire ant lesion. JAMA. Nov 1 2000;284(17):2162-3. [Medline].
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Jerrard DA. ED management of insect stings. Am J Emerg Med. Jul 1996;14(4):429-33. [Medline].
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].
Lee TH, Comes S, Burgos T. ePocrates qRx. ePocrates Inc. Available at http://www.epocrates.com/. Accessed 2000.
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Imported fire ant national distribution map. From http://fireant.tamu.edu. Reproduced with permission from B.M. Drees, Texas Imported Fire Ant Project Coordinator, Texas A&M University, College Station, Texas.

Red imported fire ant worker. From http://fireant.tamu.edu. Reproduced with permission from B.M. Drees, Texas Imported Fire Ant Project Coordinator, Texas A&M University, College Station, Texas.

Fire ant mound in lawn. From http://fireant.tamu.edu. Reproduced with permission from B.M. Drees, Texas Imported Fire Ant Project Coordinator, Texas A&M University, College Station, Texas.

Venom sac and stinger of a fire ant. From http://fireant.tamu.edu. Reproduced with permission from B.M. Drees, Texas Imported Fire Ant Project Coordinator, Texas A&M University, College Station, Texas.

Fire ant worker biting and stinging. From http://fireant.tamu.edu. Reproduced with permission from B.M. Drees, Texas Imported Fire Ant Project Coordinator, Texas A&M University, College Station, Texas.

Pustules and blisters formed following fire ant stings on the arm. From http://fireant.tamu.edu. Reproduced with permission from B.M. Drees, Texas Imported Fire Ant Project Coordinator, Texas A&M University, College Station, Texas.

Pustules and blisters formed following fire ant stings on the hand. From http://fireant.tamu.edu. Reproduced with permission from B.M. Drees, Texas Imported Fire Ant Project Coordinator, Texas A&M University, College Station, Texas.

Fire ant bites on the foot.

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