Clinical manifestation

Simple sting: results in a local reaction with swelling and pain initially and itching a few hours later; swelling sometimes increases over several days and usually resolves within one week

Immediate hypersensitivity reaction: local swelling or urticaria with pain and itching; sometimes spreads to become more generalized, with urticaria, which may progress to involve the upper or lower airway in an anaphylactic reaction

Delayed hypersensitivity reaction: either immune-complex mediated (either immunoglobulin M or immunoglobulin G)

296 Hyper-IgE syndrome or systemic (serum sickness type) or local (Arthus type); occurs within 1 week of envenomation; symptoms: fever, arthral-gias and myalgias, headache, and general malaise; signs: eruption of either red macules and papules or palpable purpura; joint swelling and tenderness with or without effusions; lymphadenopathy; glomerulitis or nephrotic syndrome Fire ant bite: usually multiple; presents as swelling and pain with early vesicle formation, followed by ulceration and possible secondary infection

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