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Picadas e ferroadas de insetos

Last reviewed: 11 Sep 2025
Last updated: 06 Dec 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • picada/ferroada testemunhada
  • edema local
  • dor local
  • calor no local
  • marcas locais
  • prurido
  • pápula e eritema
  • palidez cutânea
  • sudorese
  • sinais de comprometimento das vias aéreas
  • edema orofaríngeo
  • dispneia
  • estertores/crepitações/sibilos
  • taquicardia
  • pulso irregular
  • rubor cutâneo
  • estado de alerta alterado
Full details

Other diagnostic factors

  • pústulas
  • erupção cutânea em formato de olho-de-boi
  • erupção cutânea nas palmas das mãos e solas dos pés
  • erupção cutânea linear elevada
  • hipertensão
  • febre
  • cãibra muscular
  • diaforese
  • tremor
  • parestesia e/ou fasciculações
  • dor generalizada
  • náuseas/vômitos
  • cefaleia
  • dor abdominal
  • história de pacientes imunocomprometidos
  • história de doença cardiovascular
  • abscesso
  • necrose
  • tosse
  • hipotensão
  • artralgia
  • adenopatia
Full details

Risk factors

  • exposição ocupacional ou recreativa a insetos
  • exposição geográfica a insetos
  • história pregressa de resposta anafilática
Full details

Diagnostic investigations

1st investigations to order

  • diagnóstico clínico
Full details

Investigations to consider

  • triptase sérica
  • teste de sensibilidade
  • Hemograma completo
Full details

Treatment algorithm

INITIAL

anafilaxia

ACUTE

reação local

ONGOING

infecção secundária

Contributors

Autores

David B. K. Golden, MDCM

Associate Professor of Medicine

John Hopkins University

Baltimore

MD

Declarações

DG has received consultant fees from Novartis, rAquestive, Kokua, and Celldex (all related to anaphylaxis); clinical trial support from Genentech, GSK, Merck, Lilly, Teva, Sanofi, Regeneron, Novartis, AstraZeneca, and Pfizer (all related to non-anaphylaxis disease states); and royalties from UpToDate (related to insect allergy).

Karla E. Adams, MD

Associate Professor of Pediatrics

Uniformed Services University

Department of Medicine, Allergy and Immunology Division, Wilford Hall Ambulatory Surgical Center

San Antonio

TX

Declarações

KA received an honorarium and paid travel expenses to present lectures at the Eastern Allergy Conference and the Louisiana Society of Allergy, Asthma and Immunology on the topic of insect allergy in 2024.

Agradecimentos

David B.K. Golden and Karla E. Adams would like to gratefully acknowledge Tom Morrissey, a previous contributor to this topic.

Declarações

Not disclosed.

Revisores

Theodore M. Freeman, MD

Allergist and Immunologist

Jacobs Ramirez and Freeman Allergy & Immunology

San Antonio

TX

Declarações

TMF is an author of a number of references cited in this topic.

Andrew Parfitt, MBBS, FFAEM

Clinical Director

Acute Medicine

Associate Medical Director

Consultant Emergency Medicine

Guy's and St Thomas' NHS Foundation Trust

Clinical Lead and Consultant

Accident Emergency Medicine

St Thomas' Hospital

London

UK

Declarações

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

Jackson

MS

Declarações

RD is an author of a reference cited in this topic.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Shaker MS, Wallace DV, Golden DBK, et al. Anaphylaxis - a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020 Apr;145(4):1082-123.Texto completo  Resumo

Golden DBK, Wang J, Waserman S, et al. Anaphylaxis: a 2023 practice parameter update. Ann Allergy Asthma Immunol. 2024 Feb;132(2):124-76.Texto completo  Resumo

Golden DB, Demain J, Freeman T, et al. Stinging insect hypersensitivity: a practice parameter update 2016. Ann Allergy Asthma Immunol. 2017 Jan;118(1):28-54. Resumo

Sturm GJ, Varga EM, Roberts G, et al. EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy. Allergy. 2018 Apr;73(4):744-764.Texto completo  Resumo

Biló BM, Rueff F, Mosbech H, et al. Diagnosis of Hymenoptera venom allergy. Allergy. 2005 Nov;60(11):1339-49.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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