Pigeon tick bite: A neglected cause of idiopathic nocturnal anaphylaxis

Rolla, Giovanni; Heffler, Enrico; Boita, Monica; Doyen, Virginie; Mairesse, M.; Cvackova, Milada; Debarbieux, S.; Kleine‐Tebbe, Jörg; Ollert, Markus; Raulf, Monika; Bircher, Andreas J.; Hilger, Christiane

doi:10.1111/all.13344

Cited by 16 publications

(12 citation statements)

References 8 publications

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“…The dominant allergen Arg r 1 of 18 to 19 kd has been isolated in A. reflexus. Arg r 1 is a lipocalin and has been used as diagnostic in vitro and in vivo tool in a series of anaphylaxis caused by the pigeon soft tick [7,8]. Lipocalins are a family of extracellular proteins with a molecular weight of about 20 kd with great structural and functional diversity.…”

Section: Open Accessmentioning

confidence: 99%

Near-fatal anaphylaxis with Kounis syndrome caused by Argas reflexus bite: a case report

Boni

Incorvaia

2020

Clin Mol Allergy

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Background: The pigeon tick Argas reflexus is a temporary parasite of pigeons. It bites during night hours and lies briefly on its prey, as long as it takes the blood meal. When pigeons are not accessible, ticks look for other hosts, invading nearby flats and biting humans. Case presentation: We present the case of a woman aged 46 years who experienced severe anaphylaxis during the night which required emergency medical treatment, tracheal intubation and hospitalization in intensive care unit. Kounis syndrome was documented by transient ST depression and elevation of troponin. The allergological work up ruled out hypersensitivity to drugs, latex and foods containing alpha-gal, which is a cause of anaphylaxis. Basal serum tryptase was in normal range (8.63 ng/ml). When questioned about the presence of ticks, the patient brought into view various specimens of ticks that were recognized by an entomologist as Argas reflexus. Conclusions: An in vitro diagnosis of allergy to Argas reflexus is currently not feasible because, though the major allergen Arg r 1 has been isolated, allergen extracts are not commercially available. Therefore, the diagnosis of anaphylaxis from Argas reflexus, when other causes of anaphylaxis are excluded, must rely only on history and clinical findings, as well as on the presence of pigeons and/or pigeon ticks in the immediate domestic environment.

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Section: Open Accessmentioning

confidence: 99%

Near-fatal anaphylaxis with Kounis syndrome caused by Argas reflexus bite: a case report

Boni

Incorvaia

2020

Clin Mol Allergy

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“…There were few reported cases of nocturnal anaphylaxis which awakens patients from sleep . After ruling out possible causes of delayed anaphylaxis (eg α‐gal allergy), further investigations revealed the bite of Argas reflexus (an insect with nocturnal activity otherwise known as the pigeon tick) as the most likely trigger in those patients.…”

Section: Diagnostic Considerationsmentioning

confidence: 99%

Idiopathic anaphylaxis

Bilò

Martini

Tontini

et al. 2019

Clin Experimental Allergy

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Idiopathic anaphylaxis (IA) or spontaneous anaphylaxis is a diagnosis of exclusion when no cause can be identified. The exact incidence and prevalence of IA are not known. The clinical manifestations of IA are similar to other known causes of anaphylaxis. A typical attack is usually acute in onset and can worsen over minutes to a few hours. The pathophysiology of IA has not yet been fully elucidated, although an IgE‐mediated pathway by hitherto unidentified trigger/s might be the main underlying mechanism. Elevated concentrations of urinary histamine and its metabolite, methylimidazole acetic acid, plasma histamine and serum tryptase have been reported, consistent with mast cell activation. There is some evidence that corticosteroids reduce the frequency and severity of episodes of IA, consistent with a steroid‐responsive condition. Important differential diagnoses of IA include galactose alpha‐1,3 galactose (a carbohydrate contained in red meat) allergy, pigeon tick bite (Argax reflexus), wheat‐dependent exercise‐induced anaphylaxis, Anisakis simplex allergy and mast cell disorders. Other differential diagnoses include “allergy‐mimics” such as asthma masquerading as anaphylaxis, undifferentiated somatoform disorder, panic attacks, globus hystericus, vocal cord dysfunction, scombroid poisoning, vasoactive amine intolerance, carcinoid syndrome and phaeochromocytoma. Acute treatment of IA is the same as for other forms of anaphylaxis. Long‐term management is individualized and dictated by frequency and severity of symptoms and involves treatment with H1 and H2 receptor blockers, leukotriene receptor antagonist and consideration for prolonged reducing courses of oral corticosteroids. Patients should possess an epinephrine autoinjector with an anaphylaxis self‐management plan. There are anecdotal reports regarding the use of omalizumab. For reasons that remain unclear, the prognosis of IA is generally favourable with appropriate treatment and patient education. If remission cannot be achieved, the diagnosis should be reconsidered.

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“…It should also lead to the consideration of delayed anaphylaxis due to red meat in patients sensitized to galactose-alpha-1,3-galactose (alpha-gal) [ 11 ] . In conclusion, nocturnal anaphylaxis, combined with arachnid bites and pigeons in the neighborhood should lead to the differential diagnosis of pigeon tick allergy [ 2 ] . The recognition of anaphylaxis due to Argas refl exus requires awareness and knowledge of the behavior of this species.…”

mentioning

confidence: 98%

“…Due to the growing population of urban pigeons in European cities, the incidence of pigeon tick bites in humans and therefore the incidence of related reactions may be rising [ 1,2 ] . Due to the growing population of urban pigeons in European cities, the incidence of pigeon tick bites in humans and therefore the incidence of related reactions may be rising [ 1,2 ] .…”

mentioning

confidence: 99%