Thank you for your inquiry.
Unfortunately we do not have as much data regarding the epidemiology and outcome of fire ant stings as we do for flying hymenoptera. Therefore, much of the therapeutic strategy we apply to fire ant is actually derived from data obtained by studying patients who have reacted to flying hymenoptera. Therefore it is less evidence-based and cannot be taken as definitive. Nonetheless, our present guidelines (1) indicate that recommendations regarding immunotherapy for fire ant are generally the same as those regarding venom immunotherapy to flying hymenoptera.
With these observations in mind, I will try and answer your questions directly:
1. Although it is reasonably clear that children who experience cutaneous reactions only, if they do have a subsequent reaction, the symptoms remain cutaneous, it is still necessary, in my opinion, to prescribe an automatic epinephrine injector.
2. Since there is no indication to start immunotherapy to venom in children, there is, in my opinion, no need to retest these children. Anaphylactic events have occurred in patients with negative skin tests on rare occasion, and therefore finding negative skin tests would not alter plans for therapy, in my opinion, in this child.
3. Based upon the above observations, obviously, I would not discontinue the prescription of an automatic epinephrine injector in this case.
Unfortunately, we do not know enough about the epidemiology of fire ant reactions to know when and if a person is no longer at risk. So, we do not know exactly when to stop prescribing automatic epinephrine injectors, but safety being the first concern, at least in my opinion I would continue to prescribe them in your child.
Thank you again for your inquiry and we hope this response is helpful to you.
1. Golden DBK, et al. Stinging insect hypersensitivity: a practice parameter update 2011. J Allergy Clin Immunol 2011; 127(4):852-854.
Phil Lieberman, M.D.