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Fire Ant Bites Workup

  • Author: James P Ralston, MD; Chief Editor: Joe Alcock, MD, MS  more...
 
Updated: Oct 08, 2014
 

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:

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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.[5] 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.

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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.

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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, Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Ronald P Rapini, MD Professor and Chair, Department of Dermatology, The University of Texas MD Anderson Cancer Center; Distinguished Chernosky Professor and Chair of Dermatology, Professor of Pathology, University of Texas McGovern Medical School at Houston

Ronald P Rapini, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Society for Investigative Dermatology, Texas Medical Association

Disclosure: Received royalty from Elsevier publishers for independent contractor; May receive consulting fee from FDA panel for consulting in future, since I am on one of their committees, but at this time so far have received zero from FDA.

Specialty Editor Board

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

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, 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, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center

Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

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, Canadian Dermatology Association

Disclosure: Nothing to disclose.

References
  1. 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. 2000 Apr. 105(4):683-91. [Medline].

  2. Hoffman DR. Ant venoms. Curr Opin Allergy Clin Immunol. 2010 Aug. 10(4):342-6. [Medline].

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

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

  5. 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. 1997 Sep. 100(3):425-7. [Medline].

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

  7. La Shell MS, Calabria CW, Quinn JM. Imported fire ant field reaction and immunotherapy safety characteristics: the IFACS study. J Allergy Clin Immunol. 2010 Jun. 125(6):1294-9. [Medline].

  8. deShazo RD. My journey to the ants. Trans Am Clin Climatol Assoc. 2009. 120:85-95. [Medline]. [Full Text].

  9. [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. 2004 Oct. 114(4):869-86. [Medline]. [Full Text].

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

  11. Lee YC, Wang JS, Shiang JC, Tsai MK, Deng KT, Chang MY. Haemolytic uremic syndrome following fire ant bites. BMC Nephrol. 2014. 15:5. [Medline].

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

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

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

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

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

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

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

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

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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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