Skeeter syndrome (papular

urticaria Hives, also known as urticaria, is a kind of skin rash with red, raised, itchy bumps. Hives may burn or sting. The patches of rash may appear on different body parts, with variable duration from minutes to days, and does not leave any long-last ...

) is a localized severe allergic reaction to mosquito bites, consisting of

inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...

, peeling skin, hives, ulceration and sometimes

fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...

. It is caused by

allergen An allergen is a type of antigen that produces an abnormally vigorous immune response in which the immune system fights off a perceived threat that would otherwise be harmless to the body. Such reactions are called allergies. In technical terms ...

ic polypeptides in mosquito saliva, and therefore is not contagious. It is one of several forms, being one of the most severe, of allergic responses to mosquito bites, termed mosquito bite allergies. The condition may vary between individuals based on the reaction size and severity. Some individuals may experience reactions only to some bites and not others, thought to be attributed to varying reactions to different species of mosquitoes. Although the term seems informal, it has appeared in the published literature.

Diagnosis

Clinical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the patie ...

alone cannot distinguish between a response caused by

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...

, such as

cellulitis Cellulitis is usually a bacterial infection involving the inner layers of the skin. It specifically affects the dermis and subcutaneous fat. Signs and symptoms include an area of redness which increases in size over a few days. The borders of ...

, and skeeter syndrome. However, skeeter syndrome usually progresses over the course of hours versus cellulitis, which typically evolves over the course of several days. As such, accurate history is imperative when making the diagnosis. Since

IgE Immunoglobulin E (IgE) is a type of antibody (or immunoglobulin (Ig) " isotype") that has been found only in mammals. IgE is synthesised by plasma cells. Monomers of IgE consist of two heavy chains (ε chain) and two light chains, with the ε c ...

and

IgG Immunoglobulin G (Ig G) is a type of antibody. Representing approximately 75% of serum antibodies in humans, IgG is the most common type of antibody found in blood circulation. IgG molecules are created and released by plasma B cells. Each IgG ...

are key players in mosquito allergy,

diagnosis Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engin ...

can be confirmed by an immunosorbent assay measuring IgE and IgG to mosquito saliva antigens.

Differential diagnosis

The Skeeter syndrome should not be confused with another type of reactivity to mosquito bites, severe mosquito bite allergy (SMBA). SMBA is most often an Epstein-Barr virus-associated lymphoproliferative disease that complicates ~33% of individuals with chronic active Epstein-Barr virus infection or, in extremely rare cases, individuals with Epstein-Barr virus-positive

Hodgkin disease Hodgkin lymphoma (HL) is a type of lymphoma, in which cancer originates from a specific type of white blood cell called lymphocytes, where multinucleated Reed–Sternberg cells (RS cells) are present in the patient's lymph nodes. The condition w ...

or an Epstein-Barr virus-negative lymphoid disease such as chronic lymphocytic leukemia and

mantle cell lymphoma Mantle cell lymphoma (MCL) is a type of non-Hodgkin's lymphoma (NHL), comprising about 6% of NHL cases. There are only about 15,000 patients presently in the United States with mantle cell lymphoma. It is named for the mantle zone of the lymph n ...

. It is a

hypersensitivity Hypersensitivity (also called hypersensitivity reaction or intolerance) refers to undesirable reactions produced by the normal immune system, including allergies and autoimmunity. They are usually referred to as an over-reaction of the immune ...

reaction characterized by the rapid development of skin redness, swelling, ulcers, necrosis and scarring following mosquito bites. The reaction is often accompanied by relatively severe systemic symptoms such as fever and malaise; enlarged lymph nodes, liver, and/or spleen; liver dysfunction; hematuria; and proteinuria.

Treatment

Taking oral

cetirizine Cetirizine, sold under the brand name Zyrtec among others, is a second-generation antihistamine used to treat allergic rhinitis (hay fever), dermatitis, and urticaria (hives). It is taken by mouth. Effects generally begin within thirty minutes a ...

regularly has been known to help those who suffer from skeeter syndrome. In addition to oral steroids, topical steroids and other anti-itch creams can ease the reaction.

References

External links

Allergology Syndromes {{disease-stub