Systemic reactions
Anaphylactic reactions are rare, presumably because of the small amounts
of antigen injected during the blood meal. The most frequently reported
triggers are horse flies and kissing bugs92-96 whose
salivary glands contain ~10-30 times more protein than
those of mosquitoes.97 Anaphylaxis has also been
documented after bites from mosquitoes, tsetse flies, and louse
flies.83,98-100 Mastocytosis may be a relevant risk
factor for anaphylactic reactions.98,100
Relevant insect
species
Hematophagy has developed independently in several insect families and
is also found in some non-insect arthropods such as the ticks (Table 5).
Most blood-feeding insects belong to the order Diptera (flies and
midges). Mosquitoes, black flies, and biting midges are small
hematophagous midges with worldwide distribution often occurring locally
in huge numbers. The horse flies, tsetse flies, stable flies, and louse
flies are true flies up to 25 mm in size with a more scattered incidence
parasitizing preferably big mammals including livestock. Among
non-dipterans, the kissing bugs (Triatominae ) are of local
importance as an occasional cause of anaphylaxis, whereas the related
bed bug (Cimex ) is a highly synanthropic parasite with worldwide
distribution.