Large local reactions
Approximately 5% suffer from more severe skin reactions including large
swellings of up to 10 cm in diameter as well as vesicles and blisters
often proceeding to vasculitis and necrosis.86-88 The
underlying pathomechanisms are not well investigated. They might
represent type 1 late phase reactions, IgG-mediated type III Arthus
reactions, or pure type IV reactions.86-88 Especially
in children, skin lesions may be accompanied by fever, malaise, and
lymphadenopathy.89 Papular urticaria describes a
generalized type 4 hypersensitivity characterized by chronic recurrent
eruptions due to the bites from fleas and other
insects.90,91 The disease causes significant
morbidity, especially in children from tropical countries.