Reactions to bites from kissing bugs (primarily genus Triatoma)
- Jerome Goddard, PhD
Jerome Goddard, PhD
- Extension Professor of Medical and Veterinary Entomology
- Mississippi State University
- Richard D deShazo, MD
Richard D deShazo, MD
- Billy S Guyton Distinguished Professor
- Professor of Medicine and Pediatrics
- University of Mississippi Medical Center
- Section Editors
- David B Golden, MD
David B Golden, MD
- Section Editor — Bites and Stings
- Associate Professor of Medicine
- Johns Hopkins University School of Medicine
- Daniel F Danzl, MD
Daniel F Danzl, MD
- Section Editor — Environmental Emergencies
- Professor of Emergency Medicine
- University of Louisville School of Medicine
Triatomine insects (colloquial names include kissing bug, Mexican bed bug, and cone-nosed bug) are found primarily in the western and southern United States, in Central and South America, and in Mexico (picture 1 and picture 2). These insects feed on blood and will bite various animals and people, although humans are not a primary host .
Triatoma bites are generally painless and asymptomatic. However, reactions can occur, ranging from local irritation at the site to allergic and anaphylactic reactions.
Triatomines are also of medical interest because they are the insect vectors for the protozoan Trypanosoma cruzi, which causes Chagas disease. Triatoma and other closely related species found in the United States infrequently transmit T. cruzi, whereas the infection is endemic in some parts of South America. They do not transmit other human disease agents.
Local and allergic reactions to triatoma bites are discussed in this topic review. Chagas disease and public health measures to control populations of kissing bugs in endemic areas are presented elsewhere. (See "Chagas disease: Pathology and pathogenesis" and "Chagas disease: Epidemiology and control".)
Triatoma bites are among the most common causes of insect bite-related allergy and anaphylaxis . However, bite-induced anaphylaxis is less common than sting-related anaphylaxis, such as that induced by Hymenoptera species such as bees, wasps, and ants.
- Goddard J. Physician's guide to arthropods of medical importance, 6th ed, CRC Press Inc, Boca Raton 2013.
- Marshall NA, Street DH. Allergy to Triatoma protracta (Heteroptera: Reduviidae). I. Etiology, antigen preparation, diagnosis and immunotherapy. J Med Entomol 1982; 19:248.
- Marshall N, Liebhaber M, Dyer Z, Saxon A. The prevalence of allergic sensitization to Triatoma protracta (Heteroptera: Reduviidae) in a Southern California, USA, community. J Med Entomol 1986; 23:117.
- Klotz SA, Schmidt JO, Dorn PL, et al. Free-roaming kissing bugs, vectors of Chagas disease, feed often on humans in the Southwest. Am J Med 2014; 127:421.
- Rohr AS, Marshall NA, Saxon A. Successful immunotherapy for Triatoma protracta-induced anaphylaxis. J Allergy Clin Immunol 1984; 73:369.
- Schofield CJ, Dolling WR. Bedbugs and kissing-bugs. In: Medical insects and arachnids, Lane RP, Croskey RW (Eds), Chapman and Hall, London 1993. p.483.
- Ryckman RE. Host reactions to bug bites: literature review and annotated bibliography. Calif Vector Views 1979; 26:1.
- Edwards L, Lynch PJ. Anaphylactic reaction to kissing bug bites. Ariz Med 1984; 41:159.
- Goddard J. Kissing bugs and Chagas' disease. Infect Med 1999; 16:172.
- The University of Arisona, Cooperative Extension. The Conenose Bug (AKA "The kissing bug"). ag.arizona.edu/pubs/insects/az1109.pdf (Accessed on March 19, 2009).
- Moffitt JE, Venarske D, Goddard J, et al. Allergic reactions to Triatoma bites. Ann Allergy Asthma Immunol 2003; 91:122.
- Vetter R. Kissing bugs (Triatoma) and the skin. Dermatol Online J 2001; 7:6.
- Ryckman RE. Dermatological reactions (Hemiptera: Cimicidae). Bull Soc Vector Ecol 1985; 10:122.
- Burnett JW, Calton GJ, Morgan RJ. Triatoma: the "kissing bug". Cutis 1987; 39:399.
- Klotz JH, Dorn PL, Logan JL, et al. "Kissing bugs": potential disease vectors and cause of anaphylaxis. Clin Infect Dis 2010; 50:1629.
- Pinnas JL, Lindberg RE, Chen TM, Meinke GC. Studies of kissing bug-sensitive patients: evidence for the lack of cross-reactivity between Triatoma protracta and Triatoma rubida salivary gland extracts. J Allergy Clin Immunol 1986; 77:364.
- Riley CV, Howard LO. The "blood sucking conenose". Dept Agric Div Entomol Insect Life 1894; 6:267.
- Walter J, Fletcher E, Moussaoui R, et al. Do bites of kissing bugs cause unexplained allergies? Results from a survey in triatomine-exposed and unexposed areas in southern california. PLoS One 2012; 7:e44016.
- Lynch PJ, Pinnas JL. "Kissing bug" bites. Triatoma species as an important cause of insect bites in the southwest. Cutis 1978; 22:585.
- Lo Vecchio F, Tran TV. Allergic reactions from insect bites. Am J Emerg Med 2004; 22:631.
- Goddard J, deShazo R. Bed bugs (Cimex lectularius) and clinical consequences of their bites. JAMA 2009; 301:1358.
- Hoffman DR. Allergy to biting insects. Clin Rev Allergy 1987; 5:177.
- Simons FE, Peng Z. Mosquito allergy: recombinant mosquito salivary antigens for new diagnostic tests. Int Arch Allergy Immunol 2001; 124:403.
- Hassoun S, Drouet M, Sabbah A. [Anaphylaxis caused by a mosquito: 2 case reports]. Allerg Immunol (Paris) 1999; 31:285.
- Vidal C, Armisén M, Bartolomé B, et al. Anaphylaxis to Hippobosca equina (louse fly). Ann Allergy Asthma Immunol 2007; 99:284.
- Hrabak TM, Dice JP. Use of immunotherapy in the management of presumed anaphylaxis to the deer fly. Ann Allergy Asthma Immunol 2003; 90:351.
- Stevens WJ, Van den Abbeele J, Bridts CH. Anaphylactic reaction after bites by Glossina morsitans (tsetse fly) in a laboratory worker. J Allergy Clin Immunol 1996; 98:700.
- Commins SP, Satinover SM, Hosen J, et al. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. J Allergy Clin Immunol 2009; 123:426.
- Tavares MG, deAzeredo-Oliveira MT, Ceron CR. Tissue-specific expression of esterases in Triatoma infestans (Triatomine, Heteroptera). Genet Mol Biol 1998; 21:461.
- Chapman MD, Marshall NA, Saxon A. Identification and partial purification of species-specific allergens from Triatoma protracta (Heteroptera:Reduviidae). J Allergy Clin Immunol 1986; 78:436.
- Paddock CD, McKerrow JH, Hansell E, et al. Identification, cloning, and recombinant expression of procalin, a major triatomine allergen. J Immunol 2001; 167:2694.
- Dorn PL. Are we cuddling up to kissing bugs? Am J Med 2014; 127:361.
- http://www.cdc.gov/chagas/hcp/tx.html (Accessed on April 21, 2009).
- Risk factors
- ENTOMOLOGY OF TRIATOMA
- Worldwide distribution
- Biting behavior
- CLINICAL MANIFESTATIONS
- Local reactions
- - Differential diagnosis
- - Treatment
- Allergic reactions
- - Epidemiology of allergic reactions
- - Signs and symptoms
- - Anaphylaxis identification and treatment
- - Identification of the insect
- - Differential diagnosis
- LONG-TERM MANAGEMENT OF TRIATOMA ALLERGY
- Access to epinephrine
- Avoidance measures
- - Pesticide application
- Diagnostic tests and immunotherapy
- ADVICE ABOUT CHAGAS DISEASE AFTER A TRIATOMA BITE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS