MJA
MJA

Causes of ant sting anaphylaxis in Australia: the Australian Ant Venom Allergy Study

Med J Aust 2011; 195 (2): 69-73.

Summary

Objective: To determine the Australian native ant species associated with ant sting anaphylaxis, geographical distribution of allergic reactions, and feasibility of diagnostic venom-specific IgE (sIgE) testing.

Design, setting and participants: Descriptive clinical, entomological and immunological study of Australians with a history of ant sting anaphylaxis, recruited in 2006–2007 through media exposure and referrals from allergy practices and emergency physicians nationwide. We interviewed participants, collected entomological specimens, prepared reference venom extracts, and conducted serum sIgE testing against ant venom panels relevant to the species found in each geographical region.

Main outcome measures: Reaction causation attributed using a combination of ant identification and sIgE testing.

Results: 376 participants reported 735 systemic reactions. Of 299 participants for whom a cause was determined, 265 (89%; 95% CI, 84%–92%) had reacted clinically to Myrmecia species and 34 (11%; 95% CI, 8%–16%) to green-head ant (Rhytidoponera metallica). Of those with reactions to Myrmecia species, 176 reacted to jack jumper ant (Myrmecia pilosula species complex), 18 to other jumper ants (15 to Myrmecia nigrocincta, three to Myrmecia ludlowi) and 56 to a variety of bulldog ants, with some participants reacting to more than one type of bulldog ant. Variable serological cross-reactivity between bulldog ant species was observed, and sera from patients with bulldog ant allergy were all positive to one or more venoms extracted from Myrmecia forficata, Myrmecia pyriformis and Myrmecia nigriceps.

Conclusion: Four main groups of Australian ants cause anaphylaxis. Serum sIgE testing enhances the accuracy of diagnosis and is a prerequisite for administering species-specific venom immunotherapy.

  • Simon G A Brown1,2
  • Pauline van Eeden1
  • Michael D Wiese3,2
  • Raymond J Mullins4
  • Graham O Solley5
  • Robert Puy6
  • Robert W Taylor7,8
  • Robert J Heddle9

  • 1 Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research, Royal Perth Hospital, University of Western Australia, Perth, WA.
  • 2 Jack Jumper Allergy Program, Royal Hobart Hospital, Hobart, TAS.
  • 3 Sansom Institute, University of South Australia, Adelaide, SA.
  • 4 Faculty of Health, University of Canberra, Canberra, ACT.
  • 5 Watkins Medical Centre, Brisbane, QLD.
  • 6 Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, VIC.
  • 7 Research School of Biology, Australian National University, Canberra, ACT.
  • 8 CSIRO Division of Sustainable Ecosystems, Canberra, ACT.
  • 9 Immunology Directorate, SA Pathology, Royal Adelaide Hospital and Flinders University, Adelaide, SA.

Correspondence: simon.brown@uwa.edu.au

Acknowledgements: 

This work was funded by National Health and Medical Research Council (NHMRC) Project Grant 404050, NHMRC Career Development Award 513901 (Simon Brown), and grants by the Australasian Society of Clinical Immunology and Allergy and the Fremantle Hospital Medical Research Foundation. We gratefully acknowledge the work of our research nurses who conducted interviews and research assistants who helped to collect nests, dissect venom sacs and prepare venom extracts (Pam Hudson, Ellen MacDonald, Sharon Marsden, Kevin Mullins, Judith Hawker, Dr Susan Aulfrey). Dr Karl Bleasel (Royal Melbourne Hospital) also assisted with enrolling participants from Victoria.

Competing interests:

Raymond Mullins received unrestricted investigator-initiated grants for data purchase from CSL Limited and Alphapharm Australia (the past and current Australian distributors of EpiPen) and the Ilhan Food Allergy Foundation, Melbourne. Robert Heddle is employed by SA Pathology, which offers in-vitro diagnostic testing for specific IgE to jumper ant venom. Robert Taylor has received honoraria and travel support from the NHMRC.

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