Q:

9/23/2013
We have a patient with a history of large local reactions to Mosquito bites. He was skin tested in 2011 which was negative. He returned to the office in September of 2013 after possibly being bit by mosquitoes on multiple occasions. Each time he complains of swelling at the site, nausea, headache, light sensitivity and dizziness. Benadryl does relieve these symptoms after a couple of hours. The doctor is aware that there is the ability to desensitize patients with mosquito extract but would it still be indicated with negative skin testing?

A:

Thank you for your inquiry.

First, I recommend an excellent review article on mosquito allergy which you should read prior to proceeding with treatment. The review should be readily available to you (Crisp HC, Johnson KS. Mosquito allergy. Ann Allergy Asthma Immunol 2013 Feb;110(2):65-9. doi: 10.1016/j.anai.2012.07.023).

There are several points in this review that are salient to your inquiry, and I will mention them briefly.But you will find a very helpful, more detailed discussion of the issues brought up by your inquiry in this excellent article.

First of all, the skin test material that we have for mosquito is not highly sensitive, and false-negative tests clearly occur in a significant number of individuals who have had documented allergic reactions to mosquito bites. There are a number of reasons for this, all of which are discussed in this review.

Secondly, there is an in vitro test for specific IgE (Immunocap) to mosquito which you should consider obtaining. On occasion, this can be positive in the face of a negative skin test.

Thirdly, according to this article and to the best of my knowledge, there is no treatment extract for mosquito allergy approved by the FDA in this country. Although mosquito extracts are available from several suppliers, to my knowledge, and based upon the information in this article, none of these have been approved for use for therapy in the United States. However, desensitization to mosquito has been shown to be effective in the published literature, and these reports are discussed in the review cited above.

Finally, I would be reluctant to consider a test performed in 2011 as definitive at this time, so I would suggest performing another skin test as well as ordering the in vitro test noted above.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology