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.