Resolution of Debilitating Large Local Reaction from Imported Fire Ant Stings with Rush Immunotherapy: A Case Report

Abstract

Although treatment of systemic reactions with both flying Hymenoptera and imported fire ant (IFA) with immunotherapy is the standard of care, immunotherapy is currently not recommended for the perceived relatively minor hazard of large local reactions. However, some large local reactions can be debilitating, resulting in severe swelling, pain and discomfort as well as loss of function of an extremity. The objective of this study was to evaluate whether rush immunotherapy (RIT) with IFA whole-body extract can prevent debilitating large local reactions to the sting of the IFA. An 8-year-old boy with debilitating large local reactions to the sting of IFAs underwent a 2-day RIT protocol with IFA whole-body extract. Sting challenges were performed before, 30, and 90 days after RIT. The area of the wheal and flare were measured at 1-hour post-sting and the area of induration at 24 hours. There was a 96% increase in the 1-hour post-sting wheal at 1 month but a 60% decrease from baseline at 3 months post-RIT. The...