Child with Insect Sting Induced Anaphylaxis

Background: Anaphylaxis is an acute-onset and potentially life-threatening allergic reaction that can be caused by numerous allergic triggers. Children with asthma are at higher risk to develop anaphylaxis caused from medicines, foods, insect stings and bites.

Objective: To present a case of insect sting induced anaphylaxis in 6 years old boy with asthma history.

Methods: Six years old boy with asthma history admitted to the hospital due to severe bronchial obstruction. At admission pale, subfebrile (37,4C), with tachydispnea and weezing, using abdominal muscules, intercostal and jugular retraction. Barrel shaped chest and increased anteroposterior diameter. Auscultation-vesicular breathing with prolonged expirium and weezing. O2 sat=85%, WBC=20x10⁹/l, CRP=20mg/ml. Child was put on oxygen mask, inhalation with salbutamol, parenteralal corticotherapy and antibiotic. Continued regular inhalation maintenance therapy. On the fifth day, 15 minutes after parenteral application of Ceftriaxone child once felt the stinging pain in his right foot after it occurred aphonia, severe bronchial obstruction, swelling and redness of the face, lips, tongue, eyelids, ears and appearance of hives on the trunk and legs. Blood pressure = 90/50 mmHg, heart rate = 100/min, respiration rate = 40/min. Treated with oxygen mask, Amp. Adrenalin(1:10000) subcutaneous, anthistamines and corticosteroids intravenous, inhalation therapy with Adrenalin(1:10000), perenteral rehydration.

Results: After few hours with significantly reduction of redness and swelling on the face, lips, ears and eyelids, without hives on the trunk and legs and with easy bronchial obstruction treated inhalatory with salbutamol. Near the dorsum of the right foot was noticed insect sting with size of 2 mm. After two days child was discharged in stable condition without respiratory or other allergy symptoms.

Conclusion: Children with allergic background are at higher risk of developing anaphylaxis from various allergens, including insect stings. Those who have experienced anaphylaxis need to be provided and trained how to use auto-injectable epinephrine.