Dear DR. PAUL: My 10 year old son has mild asthma.
At this time of year he has mosquito bites, which become enlarged,
itchy and uncomfortable. Should I be giving him antihistamines
prior to prolonged exposure to mosquitoes or is there something
else that I can do to help alleviate this problem or at least
lessen his discomfort?
PEDIATRICIAN DR. PAUL Answers: Your question brings
up many important points. First, children who have asthma or other
allergies tend to have more exaggerated reactions to bites from
insects such as mosquitoes, flies and fleas. The other important
point is whether or not the reaction is local or spreads beyond
the area of the bite itself. Although much less common than a
local reaction, symptoms of a generalized or anaphylactic reaction
extend beyond the area of the bite itself and include:
Sudden difficulty breathing
Weakness or fainting
Itchy rash(hives) all over the body, not just around the
bite location itself
Swelling of the face, including on the lip or tongue area.
Anaphylactic reactions usually occur following bee, wasp or hornet
stings. If a child ever experiences such a reaction, medical attention
should be sought immediately, as unfortunately this can be fatal.
Children who have had a sting-induced generalized(anaphylactic)
reaction should have allergy tests to determine which venomous
insect they are allergic to. Only children allergic to a stinging
insect are prone to developing an anaphylactic reaction. Also,
children who have had an anaphylactic reaction to a sting will
need to carry a special medication containing adrenalin (Epipen
or Anakit)to be administered in case of a sting. The good news
is that there are specific allergy shots for bee and wasp/hornet
sting allergy that have been shown to be very effective in actually
curing or getting rid of the allergy.
Fortunately, most insect bite reactions are local and not generalized
, and although may seem large and uncomfortable, that reassuring
feature is that the reaction is indeed local. Although in most
cases it is easy to distinguish a local reaction from anaphylaxis,
if there is a doubt, do not hesitate to consult a doctor. How
do we approach a local insect bite reaction? Most insect bite
reactions can be treated quite simply by applying calamine lotion
to the area. Giving antihistamines prior to exposure to insects
does not appear to prevent reactions to bites. Insect bite reactions
usually go away within 1-3 days. If the reaction persists beyond
this or gets redder or more swollen(with or without pus), these
may be signs of an infected reaction which may need to be treated
with antibiotics. Certainly the best way to prevent a reaction,
is to try to prevent the insect bite in the first place by:
Avoiding the use of scented soaps, perfumes or hair sprays
Not dressing children in clothing with bright prints
Dressing children in long pants and light-weight long sleeved
shirts when going into an area with a lot of insects
Avoiding areas where insects are found, such as garbage
cans, pools of water(even puddles)
Using insect repellants containing DEET(no more than 10%,
and used very sparingly in younger children)
On a final note, remember that insect repellents do not prevent
stings from bees, wasps or hornets.
The information provided in this site is
designed to be an educational aid only. It is not intended to
replace the advice and care of your child's physician, nor is
it intended to be used for medical diagnosis or treatment. If
you suspect that your child has a medical condition, always
consult a physician.
