Treatment and prevention
Topical antihistamines are widely used for skin lesions despite low
evidence from controlled studies of their effectiveness and high risk of
photosensitivity.86 Early use of topical steroids may
be beneficial in preventing severe local reactions.87Pretreatment with oral antihistamines in normal daily doses
significantly reduces wheal size and itch of mosquito bite-induced
immediate reactions in adults and children.132-135
Bite avoidance is a key measure in the management of insect bite
hypersensitivity. Among insect repellents, DEET
(N,N-diethyl-3-methylbenzamide) and icaridin/picaridin are considered
the most powerful, showing efficacy against a broad array of insects as
well as ticks.136 At appropriate concentrations, both
may also be used in children 2 years and older. Optimal insect and tick
control can be achieved by additionally treating clothing and nets with
permethrin which simultaneously acts as a repellent and an
insecticide.137
Specific immunotherapy has been carried out in a limited number of
studies in adults and children with cutaneous or systemic mosquito bite
allergy.138-141 All reported a significant benefit
from immunotherapy, but study quality was throughout low in terms of
control subjects, patient number, or read-out parameters. All studies
used whole-body extracts of unknown composition and quality.