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Patients & Consumers Online Tools Find an Allergist / Immunologist Pollen Counts Diseases 101 Drug Guide Featured Resources » AAAAI Tips Brochures Topic of the Month Information Request Form Donate Now Constituencies » Patients & Consumers Contact Search by Condition (A-Z) Request a Speaker Smoke Free Homes Referral Guidelines Breakthroughs in Bioscience Other Resources En Español Just for Kids Seniors		Tips to Remember: Health hazards of imported fire ant stings Print PDF here What are fire ants? Fire ants are stinging insects that belong to the same order as bees and wasps. The red-black imported fire ant now infests more than 321 million acres in the southern United States, where it has become a considerable agricultural pest and a significant health hazard. Fire ant mounds may measure up to three feet in diameter and 18 inches in height. Each mound may be teeming with up to 250,000 worker ants that measure approximately ¼ inch in length. Fire ants may attack with little warning. After firmly grasping the skin with its jaws, the fire ant arches its back as it inserts its rear-end stinger into the flesh, injecting venom from the venom sac. It then pivots at the head and typically inflicts an average of seven to eight stings in a circular pattern. Fire ant venom is unique because of the high concentration of toxins, which are responsible for the burning pain characteristic of fire ant stings. What are reactions to fire ant stings? Fire ant sting reactions range from localized itching and swelling with pustule formation, to severe, life-threatening anaphylaxis. Almost all persons stung by fire ants develop an itchy, localized hive at the sting site which usually subsides within 30 to 60 minutes. This is followed by a small blister at the site of each sting within four hours. A sterile sore with pus forms in 8 to 24 hours; it then ruptures 48-72 hours later, followed by a scar formation in many cases. Treatment is aimed at preventing secondary bacterial infection which may occur if the pustule is scratched or broken. Diabetics and other people with circulatory disorders, including varicose veins and phlebitis, are at special risk for complications. Up to 50% of patients develop large local reactions at the site of fire ant stings. Swelling may last for several days and may be accompanied by itching, redness and pain. What is anaphylaxis? Anaphylaxis is a generalized, systemic allergic reaction to fire ant stings that may be life-threatening. It usually occurs in persons sensitized by a previous sting. It may be manifested by flushing, generalized hives, swelling of the face, eyes or throat, difficulty breathing, and loss of consciousness. A physician survey documented 32 deaths due to anaphylactic reactions to fire ant stings in patients 16 months to 65 years of age. Anaphylactic reactions should be managed as a medical emergency! If stung, persons at risk should immediately self-administer epinephrine, take an antihistamine and report to a physician or emergency room. Delay in administering epinephrine is a common and critical error. Epinephrine is the first drug of choice in the treatment of anaphylaxis. Insect sting-allergic patients should carry an emergency kit containing epinephrine (e.g., EpiPen or Twinject) for self-administration in case of a sting. Further treatment may include epinephrine, antihistamines and corticosteroids. Persons suffering fire ant sting anaphylaxis should be referred to an allergist/immunologist for skin testing and immunotherapy. How do you treat fire ant stings? Local reactions Elevate the extremity and apply ice or a cold compress to reduce swelling and relieve pain. Do not break the pseudopustule (blister). Topical steroid ointments and oral antihistamines may relieve the itching associated with these reactions. Since the swelling is due to allergy and not infection, antibiotics are usually not necessary. Seek medical attention if the swelling progresses or if infection is suspected. What are allergy shots/immunotherapy? Allergen immunotherapy (allergy shots) has proven to be an extremely effective form of treatment for individuals at risk of insect sting anaphylaxis. Anyone who has suffered a systemic allergic reaction from a fire ant sting should be referred to a trained allergist for skin testing and evaluation for immunotherapy. Fire ant whole body extract has been shown to contain relevant venom allergens and appears to be protective. The optimal duration of fire ant immunotherapy is typically at least 3-5 years, except in special cases where longer duration is thought to be necessary. In one study, immunotherapy was discontinued in 31 patients after 2-19 years of treatment. All patients tolerated a fire ant sting challenge after three months and 94% had no reaction to re-sting one year later. Treatment goals are to: Prevent allergic reactions Reduce complications Alleviate anxiety Manage anaphylaxis How can you control fire ants? Effective methods for insecticide treatment of fire ant mounds in locations that present a high risk to people and pets can be killed overnight by the use of specifically approved insecticides like Orthene. These materials are toxic as well as highly effective and should be used only in conformance with the EPA labeling. How can you prevent fire ants? Insect sting allergy is a major health hazard for a significant number of individuals in the southern United States. Fire ants have been found as far west as California and as far north as Washington D.C. Their migration appears to be limited by the frost line. Standard preventive care measures should include: Precautions for insect avoidance Prescription of emergency treatment kits containing epinephrine Referral for allergy evaluation and immunotherapy Fire ant allergic patients should wear closed-toed shoes, socks, and gloves when gardening and take other precautions to avoid stings. These preventative measures should help to reduce the health hazards caused by imported fire ant stings. When to see an allergy/asthma specialist The AAAAI’s How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they: Have reactions possibly due to insect stings for accurate identification of specific allergen and consideration for immunotherapy (allergy shots). Have systemic reactions possibly due to biting insects, for accurate identification of specific allergen Your allergist/immunologist can provide you with more information on fire ant stings. Visit www.aaaai.org for more information on allergies or to find an allergist/immunologist. Tips to Remember are created by the Public Education Committee of the American Academy of Allergy, Asthma and Immunology. The content of this brochure is for informational purposes only. It is not intended to replace evaluation by a physician. If you have questions or medical concerns, please contact your allergist/immunologist. American Academy of Allergy, Asthma and Immunology 555 East Wells Street, Suite 1100 Milwaukee, WI 53202 AAAAI Web site www.aaaai.org ©2007, American Academy of Allergy, Asthma and Immunology. All rights reserved. May not be duplicated or appropriated without permission. 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