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[Allergy] Fatal anaphylaxis due to fire ant stings

The World Allergy Organisation commemorates June 28 to July 4 as "World Allergy Week", hoping to raise public awareness of allergies. In fact, in addition to causing redness, swelling and itching, severe allergies can also cause shock.

The Allergy Medicine Association pointed out that a patient had dizziness, vomiting, and even unconsciousness after being bitten by an insect, requiring intubation and admission to the intensive care unit, and was later diagnosed with anaphylactic shock due to fire ant stings. Doctors stated that anaphylactic shock is a severe systemic allergic reaction that can be fatal if not properly treated at the time of onset. Patients may develop symptoms within seconds to minutes after exposure to allergens, resulting in a rapid drop in blood pressure and dizziness. Sensation, even loss of consciousness, and difficulty breathing.

The patient, Mr. Wu, was bitten by insects three times in 2011, 2015, and 2019. The first two times respectively caused severe swelling of his feet and loss of consciousness, and he was sent to the hospital for treatment. However, the hospital did not provide appropriate diagnosis at that time. After being bitten by an insect again last year, he developed dizziness, vomiting, and loss of consciousness, and was sent to the hospital, where he was intubated and admitted to the intensive care unit for a week.

Later, he was referred to the Clinical Immunology Department of Queen Mary Hospital. After performing a skin test, he was diagnosed with RIFA (Red Imported Fire Ants) anaphylactic shock. The doctor arranged appropriate treatment for him, prescribed an epinephrine auto-injector (commonly known as a life-saving pen), and educated him on the things he needed to take note of. He is currently undergoing sublingual desensitisation treatment.

The chairman of the Hong Kong Institute of Allergy, pointed out that anaphylactic shock patients develop symptoms within seconds to minutes of exposure to allergens, resulting in a rapid drop in blood pressure, and patients may have difficulty breathing or even lose consciousness, which can be fatal in severe cases. But last year, only about one-third of anaphylactic shock patients in Hong Kong were prescribed life-saving injections, which is considered a lower rate. It is hoped that the government can increase resources and the training of immunologists to handle patients with allergies.

In addition, sublingual desensitisation immunotherapy is also one of the methods to be considered. However, the patient needs to continue this treatment for a long time, using a nebulizer once a day to spray the solution containing the allergen under the tongue, dose will be gradually increased every day. The purpose is to let the immune system gradually adapt to the allergens, so that the body can reduce the allergic reactions, but in the early stage of treatment, there may be swelling of the gum.

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A study published by the University of Hong Kong earlier this year pointed out that among adult patients from the Clinical Immunology Department of Queen Mary Hospital in 2018/19, more than one adult had "spontaneous" anaphylactic shock, and that the cause of allergen was unknown. Less than one-third of these patients were prescribed a life-saving shot before diagnosis. From 2009 to 2019, the number of hospital admissions due to anaphylactic shock continued to rise. Although the percentage of patients prescribed "life-saving shots" also increased, it was still far behind the number of patients admitted to hospital due to allergies.

Source: https://hk.on.cc/hk/bkn/cnt/news/20200627/bkn-20200627135720691-0627_00822_001.html

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