Home            Past Issues            About IP            About IAP           Author Information            Subscription            Advertisement              Search  

   
case reports

Indian Pediatr 2013;50: 423-424

Angioedema Following Ingestion of Fried Flying Red Fire Ants


V Nandhakumar

From Department of Pediatrics, Melmaruvathur Adhiparasakthi Institute of Medical Sciences Hospital, Melmaruvathur, Kancheepuram, Tamilnadu 603 319, India.

Correspondence to: Dr V Nandhakumar, B-6, Lakshmi apartments, Meenambal Street, Melmaruvathur,
Kancheepuram, TN 603 319, India.
Email: [email protected]

Received: September 18, 2012;
Initial review: September 24, 2012;
Accepted: October 31, 2012.


Red ants’ sting anaphylaxis was rarely reported from India. But angioedema due to ingestion of fried "flying red fire ants" in children is almost never reported from India and also very rarely reported from outside India. We report a case of recurrent non allergic angioedema following ingestion of fried flying red ants.

Key words: Angioedema, Fried flying red ants, Ingestion, Child.



Red fire ant (Solenopsis Geminata Fabricius) sting can cause allergy from local reactions to anaphylaxis [1]. However, angioedema due to ingestion of cooked ‘flying red fire ants’ in children has not been reported earlier.

Case Report

An 8-year-old boy was rushed to the pediatric emergency room of our hospital with the complaints of rapidly progressive swelling of within last 5 minutes. Swelling of face was first noticed in lips (Fig.1), periorbital region, ear lobules and then rapidly progressed to entire face. There was no history of breathlessness, pain or itching. There was no rash, but angioedema of face was noted. His vital parameters were normal. Mother gave the history of ingestion of fried flying ants (Fig. 2).

Fig. 1 Angioedema of lips.


Fig.2 Fried flying red fire ants.

The reasons behind the ingestion of flying ants given by the mother were high iron content, improve the fertility status of the person and good taste. She also gave the past history of similar event but of lesser severity, since last one year. No other family members developed allergy or angioedema on ingesting the same dish. Investigations showed normal total count of 8300/mm3, differential count of P58, L34, M1 and E7 and absolute eosinophil count of 250/mm3. Serum C1 esterase level was normal. Urine examination and renal function tests at admission and discharge were within normal limits.

The child was treated with intravenous hydrocortisone and antihistaminics. Edema started to decrease after 4 hours of management and the child recovered fully by 24 hours.

Discussion

Insects of the order hymenoptera, members of genus Solenopsis namely S. invicta, S richteri and S geminate, have a stinging apparatus at the tail end of their abdominal segment and are capable of delivering 100 ng of venom. The venom has various peptide and protein components and some of which are capable of inducing vasoreactive substances. It has been estimated that 1500 stings would be required to deliver a lethal dose of hymenoptera venom for a non allergic adult weighs 70 kg [2]. Ninety-nine percent of the alkaloid component of red fire-ant venom is made up of 2, 6, di-substituted piperidines that have hemolytic, antibacterial, insecticidal, and cytotoxic properties. Venom alkaloids do not generate IgE antibody responses and thus do not appear to be responsible for allergic reactions [3]. Anaphylaxis is more common and severe in subsequent stings [4]. Serious complications like laryngospasm, seizures, rhabdomyolysis and acute renal failure were reported [5].

Allergic angioedema typically occurs within several minutes of exposure to insect stings. In the above case angioedema started after 5 hours of exposure without pruritus and urticarial rash suggesting non allergic etiology due to excess bradykinin release. The close differential diagnosis is C1 esterase inhibitor deficiency, either hereditary or acquired, causing angioedema. This was ruled out in the above case by normal C1 esterase inhibitor level. The etiology of red ants’ ingestion was concluded also on the basis of recurrent presentation on exposure to the same.

References

1. Havaldar PV, Patil SS, Phadnis C. Anaphylaxis due to red fire ant bite. Indian Pediatr. 2012; 49:237-8.

2. Freeman TM. Hypersensitivity to hymenoptera stings. N Engl J Med. 2004;351;1978-84.

3. DeShaze RD, Butcher BT, Banks WA. Reactions to the stings of imported fire ant. N Engl J Med. 1990;323:462-6.

4. Goddard J, Jarratt J, de Castro FR. Evolution of the fire ant lesion. JAMA. 2000;284:2162-3.

5. Koya S, Crenshaw D, Agarwal A. Rhabdomyolysis and acute renal failure after fire ant bites. J Gen Intern Med. 2007;22:145-7.

 

Copyright 1999-2012 Indian Pediatrics