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J Cutan Pathol 2017 Dec 21;44(12):1012-1017. Epub 2017 Sep 21.

Department of Dermatology and Cutaneous Surgery, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, Florida.

Background: Skin reactions to the sting of the imported fire ant have characteristic clinicopathological features.

Methods: One case of experimental envenomation was prospectively followed during 48 hours, with biopsies. In addition, 6 cases from our laboratory were retrospectively evaluated histopathologically for the following features: spongiosis, exocytosis (and type of cells), pustule formation, erosion/ulceration, epidermal necrosis, scale/crust, papillary dermal edema, inflammatory dermal infiltrate (cell type, density, depth, distribution, shape), red blood cell extravasation, vasculopathy and vasculitis. Read More

Asian Pac J Allergy Immunol 2018 06;36(2):101-108

Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.

Background: Specific IgE against Solenopsis invicta (imported fire ant) remains the current diagnostic tool for allergy to ants worldwide. However, S. invicta may not be the only cause of ant anaphylaxis in Thai patients. Read More

Asian Pac J Allergy Immunol 2015 Dec;33(4):267-75

Department of Medical Entomology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

Hypersensitivity reactions caused by ant stings are increasingly recognized as an important cause of death by anaphylaxis. Only some species of ants ( e.g. Read More

Mol Immunol 2016 Jan 28;69:24-32. Epub 2015 Nov 28.

Molecular Allergy Research Laboratory College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia; Centre for Biodiscovery and Molecular Development of Therapeutics, James Cook University, Townsville, QLD, Australia. Electronic address:

The main insects causing allergy reactions to stinging insect in humans are Apidae (bees), Vespidae (wasps, yellow jackets and hornets) and Formicidae (ants). Their venom stings are composed of various biologically active peptides and protein components, some of which can cause toxicity or anaphylaxis in humans. The protein venom demonstrate some common allergenic activity such as for fire ants and vespids, which have two common allergens that are phospholipase A1 (enzymatic activity) and antigen 5 with unknown biological activity. Read More

An Bras Dermatol 2015 May-Jun;90(3 Suppl 1):22-5

Universidade de São Paulo, São Paulo, SP, BR.

Ants are social insects with species of medical interest, such as the fire ants (Solenopsis sp.). The sting causes inflammation, vesicles and sterile pustules, which may cause allergic phenomena and even anaphylactic shock. Read More

J Allergy Clin Immunol Pract 2015 May-Jun;3(3):315-22; quiz 323

Ellsworth and Mabel Simmons Professor of Allergy and Immunology, Morsani College of Medicine, University of South Florida and James A. Haley VA Hospital, Tampa, Fla. Electronic address:

Stinging insect allergy is responsible for more than 10% of all cases of anaphylaxis. The potential culprit insects are diverse and vary with geography. The incidence of insect allergy is declining in some areas and increasing in others, possibly due to effects of climate change, introduction of species into new areas, outdoor recreational activities, and movement of human populations that brings insects into contact with a greater number of people. Read More

Hautarzt 2014 Sep;65(9):775-9

Floridsdorfer Allergiezentrum, Franz Jonas Platz 8/6, 1210, Wien, Österreich,

Simultaneous reactivity with the venoms of different Hymenoptera is commonly seen in patients allergic to insect venoms. Strong, though individually variable, cross-reactivity occurs between the venoms of different Vespinae species (Vespula, Dolichovespula, Vespa). In Middle Europe, anaphylaxis after European hornet stings is nearly always due to cross-reactivity with Vespula venom. Read More

BMC Nephrol 2014 Jan 8;15. Epub 2014 Jan 8.

Division of Nephrology, Department of Internal Medicine, E-Da Hospital/ I-Shou University, No,1, Yida Rd,, Yanchao Dist,, Kaohsiung City 824, Taiwan.

Background: Haemolytic-uremic syndrome (HUS) is a severe, life-threatening disease with symptoms such as haemolytic anaemia, renal failure, and a low platelet count. Possible aetiology includes bacterial infections, medication, post-hematopoietic cell transplantation, pregnancy, autoimmune disease, and acquired immunodeficiency syndrome.

Case Presentation: We report the case of a 21-year-old healthy man who developed acute renal failure caused by HUS. Read More

Ann Allergy Asthma Immunol 2013 Dec 18;111(6):562-6. Epub 2013 Sep 18.

San Antonio Military Medical Center, San Antonio, Texas. Electronic address:

Background: Rush immunotherapy (RIT) schedules can expedite protection in individuals sensitive to imported fire ant (IFA) stings.

Objective: To evaluate the safety and efficacy of 1-day RIT with IFA whole body extract (WBE) and determine the benefit of premedication with antihistamines and prednisone.

Methods: Patients with systemic reactions to IFAs and evidence of specific IgE by skin test or serologic test started a 1-day RIT protocol without premedication. Read More

Insect Sci 2013 Aug 11;20(4):439-55. Epub 2013 Feb 11.

Department of Entomology, Texas A&M University, Collage Station, TX, 77843, USA.

The impact of the imported fire ant (IFA) is complex, in large part, because several very different species of "Fire Ants" have invaded and one of these has two forms, all of which are hard to separate by the public, as well as, some investigators not focused on the ant. Each of these different "IFA" species and forms differ in their impact. Further, these ants impact a number of "things" ranging from the environment and wildlife (plants and animals) as well as people, their environment and infrastructure. Read More

Curr Opin Allergy Clin Immunol 2013 Aug;13(4):372-8

United States Department of Agriculture, Agricultural Research Service, Center for Medical, Agricultural and Veterinary Entomology, Gainesville, Florida 32608, USA.

Purpose Of Review: To describe the current efforts to use biological control agents to reduce fire ant population levels, thus ultimately reducing the number of human sting and allergic reaction incidents.

Recent Findings: Climate change and worldwide fire ant expansion will increase the frequency of human encounters and allergenic events, putting additional pressure on the public health sector. Six species of fire ant decapitating flies are now established in the United States. Read More

Allergy Asthma Proc 2013 Mar-Apr;34(2):179-84

Ireland Army Community Hospital, Department of Allergy–Immunology, Fort Knox, Kentucky 40121, USA.

Insect venom hypersensitivity can pose a threat to personnel deployed to a combat zone but the exposure risk in Afghanistan is currently unknown. This study was designed to assess the threat of Hymenoptera stings and associated allergic reactions in Afghanistan. Hymenoptera species were collected during a deployment to southern Afghanistan from June 2010 through January 2011. Read More

Am J Emerg Med 2013 Mar 21;31(3):632.e1-3. Epub 2013 Jan 21.

Division of Pediatric Critical Care Department of Pediatrics Medical University of South Carolina Charleston, SC, USA.

Allergy Asthma Proc 2012 May-Jun;33 Suppl 1:12-14

The Hymenoptera order is divided into three families: Apids, Vespidae, and Formicidae. Apids include the honeybee, bumblebee, and sweat bee, which are all docile and tend to sting mostly on provocation. The Africanized killer bee, a product of interbreeding between the domestic and African honeybee, is very aggressive and is found mostly in Mexico, Central America, Arizona, and California. Read More

Indian Pediatr 2012 Mar;49(3):237-8

Chaitanya Childrens Hospital, Karnataka, India.

Ant allergy is a rare problem and most published reports are from outside India. We report a toddler who suffered from severe anaphylaxis reaction due to bite of Red fire ant (Solenopsis geminata). Read More

J Allergy Clin Immunol 2010 Jun 7;125(6):1294-9. Epub 2010 May 7.

Department of Allergy and Immunology, David Grant USAF Medical Center, Travis Air Force Base, CA 94535, USA.

Background: Imported fire ants (IFAs) are endemic in the southeastern United States, including Texas; can sting multiple times; and are a well-known cause of anaphylaxis. There are few data available on how many stings typically lead to systemic reactions (SRs). Likewise, there are no reports currently in the literature that characterize the safety of IFA subcutaneous immunotherapy (SCIT). Read More

Curr Opin Allergy Clin Immunol 2010 Aug;10(4):342-6

Brody School of Medicine at East Carolina University, Greenville, North Carolina 27834, USA.

Purpose Of Review: The review summarizes knowledge about ants that are known to sting humans and their venoms.

Recent Findings: Fire ants and Chinese needle ants are showing additional spread of range. Fire ants are now important in much of Asia. Read More

Ann Allergy Asthma Immunol 2009 Oct;103(4):337-41

Medical College of Georgia, Department of Allergy and Immunology, Augusta, GA 30912-3790, USA.

Background: Previous studies suggest that small antigen doses given frequently are more likely to induce IgE production than are large antigen doses given infrequently.

Objective: To compare the prevalence of antitetanus IgE resulting from the relatively large dose of tetanus toxoid delivered by standard immunizations at 2, 4, 6, and 18 months of age with the previously reported prevalence of anti-fire ant venom IgE resulting from the relatively small dose of venom delivered sporadically by accidental fire ant stings in children younger than 5 years.

Methods: This study uses previously published data on the prevalence of IgE antibodies to imported fire ant venom among children living in an imported fire ant endemic area of Georgia and antitetanus IgE measurements of children recruited between August 1, 2003, and December 30, 2007, as part of the Wayne County Health, Environment, Allergy, and Asthma Longitudinal Study in Michigan, where there are no imported fire ants. Read More

Trans Am Clin Climatol Assoc 2009 ;120:85-95

University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi 39216, USA.

In this paper, I review the strange, unplanned and unexpected journey I have had with Solenopsis invicta, the imported fire ant. Through serendipity, good fortune and repeated invenomation, I have come to count as collaborators a number of entomologists, toxicologists, allergists and immunologists who have guided me on this journey to the ants. We now understand the mechanisms for the cutaneous reactions experienced by 50% of the exposed population stung per year, as well as the immunologic and toxicologic properties of the ants unique venom. Read More

J Exp Zool A Ecol Genet Physiol 2010 Jan;313(1):17-23

Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut, USA.

Invasive species can impose novel selection pressures on natives, such as toxins to which native taxa are not adapted. Native species may survive such invasions by evolving mechanisms to avoid toxin exposure or increase toxin tolerance. Red imported fire ants (Solenopsis invicta) employ an alkaloid-based venom to defend their colonies and capture prey. Read More

Ann Allergy Asthma Immunol 2009 May;102(5):422-5

Department of Allergy & Immunology, Walter Reed Army Medical Center, Washington, DC, USA.

Background: No large evaluation has been performed of the maintenance vial concentration commonly used by physicians when prescribing imported fire ant (IFA) immunotherapy since the publication of the first Stinging Insect Hypersensitivity Practice Parameter 10 years ago.

Objective: To describe the prescribing patterns for IFA immunotherapy among practicing allergists in a large health care setting and the impact of published Practice Parameter recommendations.

Methods: Data from the US Army Centralized Allergen Extract Laboratory were analyzed to determine IFA immunotherapy prescribing patterns from 1990 to May 2007. Read More

Ann Allergy Asthma Immunol 2009 Apr;102(4):303-7

Wilford Hall Medical Center, Lackland AFB, San Antonio, Texas 78236, USA.

Background: Imported fire ant (IFA) stings are an important cause of stinging insect hypersensitivity in endemic areas. IFA stings are difficult to avoid, and many studies have shown high field sting rates. No studies report the natural IFA sting rate that patients experience while receiving IFA immunotherapy. Read More

Ochsner J 2008 ;8(3):114-8

Purpose: To describe a case of eosinophilic fasciitis likely related to proximate fire ant bites and review the literature to summarize the etiology and clinical, laboratory, histopathological, and therapeutic aspects of eosinophilic fasciitis.

Methods: Report of a case of eosinophilic fasciitis and review of the English language literature using a Medline search from 1950 to January 2007.

Results: We describe the case of a New Orleans woman who developed eosinophilic fasciitis after fire ant bites post-Hurricane Katrina. Read More

Ann Allergy Asthma Immunol 2008 Sep;101(3):311-5

Department of Allergy and Immunology, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas, USA.

Background: Young children with a history of systemic reactions to imported fire ant (IFA) stings are at substantial risk of recurrent stings because of their maturational inability to practice appropriate avoidance techniques.

Objective: To present 3 cases in which patients 36 months or younger completed a 1-day rush immunotherapy (RIT) protocol with IFA whole-body extract (WBE).

Methods: The 1-day RIT protocol used for these patients was modified from the Wilford Hall 2-day rush protocol previously published. Read More

Curr Opin Allergy Clin Immunol 2008 Aug;8(4):354-9

Department of Allergy and Immunology, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas 78236, USA.

Purpose Of Review: Imported fire ants pose a real and present danger to allergic individuals living in endemic areas. This overview examines the impact of their presence, specifics of their venom and approach to the treatment of the hypersensitive individuals.

Recent Findings: Imported fire ant sting attack rates are high in endemic areas with sensitization occurring early in life among those dwelling in these locations. Read More

Am J Forensic Med Pathol 2008 Mar;29(1):62-3

Department of Allergy and Immunology, Luke AFB, Arizona 85309, USA.

The red (Solenopsis invicta) and black (Solenopsis richteri) imported fire ants (IFA) are a common cause of venom allergy in the southeastern United States. Hypersensitivity to stings of native fire ants is less common, although anaphylaxis has been reported to various native Solenopsis species. There have been numerous reports of indoor stings caused by IFA, including in nursing homes and private residences. Read More

Ann Allergy Asthma Immunol 2008 Jan;100(1):54-8

Department of Allergy/Immunology, Medical College of Georgia, Augusta, Georgia 30912, USA.

Background: Imported fire ant (IFA) stings are common in children in the southeastern United States, but little is known about antibody responses to stings.

Objectives: To examine the prevalence of detectable IgE and IgG antibodies to IFA venom (IFAV) and to assess the frequency of IFA stings in children in an endemic region.

Methods: We measured IFAV specific IgE using the ImmunoCAP assay and IgG anti-IFAV using protein G solid-phase radioimmunoassay in 183 serum samples from children living in the southeastern United States. Read More

Southeast Asian J Trop Med Public Health 2007 Sep;38(5):808-13

Preventative Medicine and Occupational Health, International SOS, Kuala Kencana, Papua, Indonesia.

Severe cutaneous allergic vasculitis in a 60 year-old Caucasian male following the bite of the tropical fire ant, Solenopsis geminata (F.) is reported. Over the course of 8 weeks, the pathology progressed from an extensive red papular urticaria to vasculitis with peri-vascular inflammation and ulceration of the skin on the feet, ankles and lower limbs. Read More

Allergy Asthma Proc 2007 Jul-Aug;28(4):485-8

Department of Pediatrics, United States Air Force Academy, Colorado 80840, USA.

As imported fire ants (IFAs) expand their range, hypersensitivity reactions to their stings are becoming a significant cause of morbidity and mortality in the United States. Currently, IFAs whole body extract (WBE) immunotherapy is the mainstay of treatment for IFA hypersensitivity but the optimal duration of treatment is unknown. A questionnaire was administered to patients diagnosed with IFA venom hypersensitivity based on history and the presence of IFA venom-specific IgE who had been offered immunotherapy. Read More

J Gen Intern Med 2007 Jan;22(1):145-7

Internal Medicine Residency Program, University of Alabama at Birmingham, Montgomery, AL 36116, USA.

We describe a 59-year-old patient who developed acute renal failure because of rhabdomyolysis after extensive red fire ant bites. This case illustrates a serious systemic reaction that may occur from fire ant bites. Consistent with the clinical presentation in rhabdomyolysis associated with non-traumatic causes, hyperkalemia, hypophosphatemia, hypocalcemia, and high anion gap acidosis were not observed in this patient. Read More

J Investig Allergol Clin Immunol 2007 ;17(1):48-9

Allergy Service, Carlos Haya University Regional Hospital, Málaga, Spain.

A 27-year-old woman suffered from anaphylaxis after being stung by Solenopsis invicta ants while she was handling wood from South America. The patient reported no previous adverse reactions to stings by other hymenopteran species. Intradermal skin tests with hymenoptera venom (Vespula vulgaris, Polistes species, Apis melifera) were negative. Read More

Clin Tech Small Anim Pract 2006 Nov;21(4):194-204

Alameda East Veterinary Hospital, Denver CO 80231, USA.

The medically important groups of Hymenoptera are the Apoidea (bees), Vespoidea (wasps, hornets, and yellow jackets), and Formicidae (ants). These insects deliver their venom by stinging their victims. Bees lose their barbed stinger after stinging and die. Read More

Saudi Med J 2006 Nov;27(11):1761-3

Division of Dermatology, Department of Medicine, King Fahad National Guard Hospital, King Abdul-Aziz Medical City, Riyadh, Kingdom of Saudi Arabia.

Ant allergy is a rare clinical problem that ranges from local to systemic reaction and life-threatening anaphylaxis. Different types of ants including the imported fire ants, the black (samsum) ants, and others, are considered health hazard in many parts of the world. We report a 32-year-old Saudi female from Hafr-Al-Batin in the Northern region of Saudi Arabia, with history of recurrent anaphylaxis following black (samsum) ant stings and we review the related literature. Read More

Vet Dermatol 2006 Dec;17(6):453-5

Departamento de Veterinária, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil.

This paper reports a case of spontaneous fire ant sting dermatitis in canine. The skin lesions consisted of nonfollicular, grouped pustules in the abdominal region. Several fire ants were found attached to the lesional skin. Read More

Ann Allergy Asthma Immunol 2006 Aug;97(2):223-5

Allergy/Immunology, Wilford Hall Medical Center, Lackland AFB, Texas 78236, USA.

Background: The Joint Task Force on Practice Parameters for Allergy and Immunology recommends that patients with a history of a systemic reaction to an insect sting be educated on ways to avoid insect stings, carry injectable epinephrine for emergency self-treatment, undergo specific IgE testing for stinging insect sensitivity, and be considered for immunotherapy.

Objective: To review frontline providers' documented care and recommendations for imported fire ant and flying insect hypersensitivity reactions.

Methods: A retrospective medical record review was performed of emergency department and primary care clinic visits between November 1, 1999, and November 30, 2004. Read More

Wilderness Environ Med 2006 ;17(1):21-5

Darnall Army Community Hospital, Fort Hood, TX, USA.

Objective: To evaluate the efficacy of the commercially available product Mitigator Sting and Bite Treatment in reducing the pain after imported fire ant stings.

Methods: Twenty-four volunteer subjects were exposed to imported fire ant stings on both fore-arms. The subjects received Mitigator paste on 1 arm and calamine lotion on the opposite arm, in a blinded manner, from 90 seconds to 10 minutes after exposure. Read More

Am J Med Sci 2006 Mar;331(3):134-8

Division of Clinical Immunology and Allergy, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.

Objective: We have previously reported 10 indoor sting attacks by imported fire ants, most of which involved frail elderly people in the Southeastern United States. Since the range of these insects is expanding and attacks often attract media attention, we hypothesized that additional attacks of which we were unaware may have occurred and were reported in local newspapers.

Methods: We searched the archives from 1989 until 2004 of 182 US newspapers in fire ant endemic areas in 10 states. Read More

Ann Allergy Asthma Immunol 2005 Nov;95(5):418-25

Department of Entomology, University of California, Riverside 92521, USA.

Objective: To identify ants other than Solenopsis invicta and Solenopsis richteri reported to cause adverse reactions in humans.

Data Sources: We conducted a literature review to identify reports of medical reactions to ants other than S. invicta and S. Read More

Ann Allergy Asthma Immunol 2005 Oct;95(4):344-9

Mississippi Department of Health, General Environmental Services, Jackson 39215, USA.

Background: Fire ant stings lead to significant morbidity and mortality each year. Virtually no information exists in the scientific literature about the effectiveness of personal protection measures against these ants.

Objectives: To quantify the level of protection from ant stings by socks and cotton tights and to evaluate the efficacy of repellents and other chemicals in preventing stings. Read More

Singapore Med J 2005 Oct;46(10):535-9

Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.

Introduction: To study the profile of patients with allergy to the venom of insect stings.

Methods: 31 consecutive cases referred to our clinical immunology/allergy outpatient service from June 1, 1998 to June 30, 2002 were reviewed.

Results: These patients comprised 3. Read More

Curr Opin Allergy Clin Immunol 2005 Aug;5(4):349-54

Division of Allergy and Immunology, Queen's University, Kingston, Ontario, Canada.

Purpose Of Review: Allergy to insect stings remains a hazard worldwide and is the object of updated guidelines on management. This paper reviews the various clinical responses that may occur following an insect sting.

Recent Findings: Although the general population is at slight risk, certain groups are more susceptible, including occasionally stung adult male agricultural workers, hobby honey beekeepers and family members of beekeepers. Read More

Clin Infect Dis 2005 May 24;40(9):e75-7. Epub 2005 Mar 24.

Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chia-Yi, Hsien 613, Taiwan.

We describe a case of Vibrio fluvialis hemorrhagic cellulitis and cerebritis following multiple fire-ant stings and wading in brackish water. A high index of suspicion is required for diagnosis of this specific pathogen and concordant infection. This is, to our knowledge, the first report of this type of wound infection. Read More

Hong Kong Med J 2005 Apr;11(2):131-2

Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong.

Ann Allergy Asthma Immunol 2005 Mar;94(3):387-90

Allergy/Immunology, Wilford Hall Medical Center, San Antonio, Texas, USA.

Background: There are no published data on the natural history of large local and generalized cutaneous reactions to imported fire ant (IFA) stings in children.

Objective: To determine the natural history of large local and generalized cutaneous reactions to IFA stings in children not treated with immunotherapy by reviewing medical records from a venom clinic during the past 20 years.

Methods: Patients were selected for the study if they were 16 years or younger at the time of the reaction, had only cutaneous symptoms (generalized cutaneous or large local), and did not initiate immunotherapy. Read More

Cutis 2005 Feb;75(2):85-9

Department of Dermatology, Walter Reed Army Medical Center, Washington, DC, USA.

Ann Allergy Asthma Immunol 2005 Feb;94(2):301-6

Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.

Background: Many studies are available on systemic reactions to ant sting, but few have described the direct role of ants in respiratory allergy. The nonstinging house ant, Monomorium pharaonis (pharaoh ant), is a highly infesting species in indoor environments.

Objective: To determine whether the pharaoh ant is an indoor source of aeroallergens. Read More

South Med J 2004 Jul;97(7):707-9

Department of Internal Medicine, Darnall Army Community Hospital, Ft. Hood, TX, USA.

The case is reported of an elderly patient with known previous exposure to fire ant stings, and who presented with hand-foot syndrome (HFS) in the setting of multiple fire ant stings to the lower extremities. Both hands and both feet were red, swollen, and mildly tender. Treatment was with fluocinonide cream, and all symptoms resolved as the classic fire ant skin lesions regressed. Read More

Am J Med 2004 Jun;116(12):843-6

Division of Allergy and Immunology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.

We review the medical reports of fire ant attacks on residents of nursing homes in the context of the medical entomology of these insects, and present recommendations to prevent and manage future attacks. Two reports were recent cases, while a computer-assisted search yielded four other similar cases of attacks by foraging fire ants in the last 10 years. One patient experienced an anaphylactic reaction and 4 patients died within 1 week of the attack. Read More

J Agromedicine 2004 ;9(2):309-14

Foothills Allergy and Asthma Associates, 98 Willow Lane, Sparatanburg, SC 209307, USA.

Two clinical cases illustrate near-fatal reactions to fire ant venom encountered by an infant playing in the backyard, and by a pharmacist working indoors in a hospital setting under a ceiling ventilation duct. Read More