Reactions range from local irritation and mild swelling to gross oral swelling and difficulty breathing.
Treatment is usually entirely supportive, aimed at alleviating immune reactions. Severe reactions and anaphylaxis require immediate intervention to maintain airway patency and prevent cardiovascular collapse. Injected epinephrine is the mainstay treatment of severe reactions.
Fatal spider bites are exceedingly rare. Most spider bites can be treated with supportive care.
Guidelines are mainly based on clinical experience and expert consensus due to the variability and unpredictability of reactions.
There is a risk of late-phase (delayed) anaphylactic reactions.
Primary care physicians should be notified of severe reactions involving their patients.
The term "insect" refers to a distinct taxonomic class. However, it is used generically throughout this topic to represent a multitude of bugs, including arachnids. Encounters with insects or arachnids can result in bites or stings.
Bites stem from puncture with a proboscis (head appendage) or fangs, or from chewing with mouth parts. Depending on the source, bites range from being immediately painful to completely unfelt, and health consequences may be caused by local trauma, the injection of various substances (irritants, venoms, poisons, toxins, anesthetics, enzymes, anticoagulants), disease transmission, secondary infection, or systemic allergic reactions (rare).
Stings from insects are administered from ovipositors (organs used for laying eggs that may also inject various noxious substances) or modified ovipositors (e.g., barbed stingers of bees and wasps). Stings are almost always immediately painful. Reactions range from local irritation and swelling to life-threatening anaphylactic reactions.
History and exam
- bulls-eye-shaped rash
- rash on palms and soles
- linear raised rash
- muscle cramp
- paresthesia and/or fasciculations
- generalized pain
- abdominal pain
- history of immunocompromised state
- history of cardiovascular disease
Tom Morrissey, MD, PhD
Department of Emergency Medicine
University of Florida
TM declares that he has no competing interests.
Tom Morrissey would like to gratefully acknowledge the assistance of Richard Vetter (MS) from the Department of Urban Entomology at the University of California.
Theodore M. Freeman, MD
Allergist and Immunologist
Jacobs Ramirez and Freeman Allergy & Immunology
TMF is an author of a number of references cited in this topic.
Andrew Parfitt, MBBS, FFAEM
Associate Medical Director
Consultant Emergency Medicine
Guy's and St Thomas' NHS Foundation Trust
Clinical Lead and Consultant
Accident Emergency Medicine
St Thomas' Hospital
AP declares that he has no competing interests.
Richard DeShazo, MD
Chairman and Professor
Department of Medicine
Professor of Pediatrics
Billy S. Guyton Distinguished Professor
University of Mississippi Medical Center
RD is an author of a reference cited in this topic.
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