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.