Volume 164, December 2023, Pages 153-158Author links open overlay panel, , , Abstract

Mosquito allergy has been conceived as the cutaneous reactions that appears during and after mosquito biting process; a perception that is supported by several scientific research. Additional data have led to conceive that other manifestations of allergic responses may occur as a cause of the exposure to somatic mosquito allergens. Two main phenotypes of mosquito allergy are identifiable: the cutaneous allergic reactions, induced by salivary allergens, and other manifestations of the allergic responses such as asthma and allergic rhino conjunctivitis that are caused by somatic allergens. The cutaneous reactions have kept the focus of attention of the scientific community. It appears as skin lesions that resembles the phenotype of papular urticaria with a defined natural history of the disease. Although these two phenotypes of mosquito allergy seem to be well differentiated in terms of the allergens that are involved and the routes of exposures, other factors such as geographical distribution, may participate. Mosquitoes have adapted to the host immune response against bites, producing immunomodulatory molecules that counteract such defensive response. The role that the immunomodulatory molecules have on the allergic immune response has not been studied yet and it is still not known if affects all mosquito allergy phenotypes. Only a few studies of allergen specific immunotherapy for cutaneous allergic reactions induced by mosquito bites have been done, and none for respiratory allergic responses. The clinical practice focuses on symptom management and avoiding mosquito bites as much as possible. Avoiding mosquitoes, using different well described methods, is still the best option to limit contact with these insects. The lack of knowledge of mosquito allergy have raised several questions that affects the clinical management of this allergic disease, from its diagnosis, prevention and immunotherapy.

Section snippetsMosquitoes, allergic diseases and bite-related reactions

Mosquitoes are one of the most dangerous animal species on the planet and represent a serious public health issue. More than one million people die every year by mosquito-borne diseases and about 700 millions of humans are affected by these kind of illnesses (Caraballo and King, 2014). The biggest threats for human health are infectious diseases where mosquitoes participate as vectors, spreading germs such as viruses and parasites which cause West Nile virus infection, Chikungunya, Dengue,

Immunomodulatory salivary components versus host immune response during mosquito bites

A successful blood feeding requires the ability of mosquitoes to counteract the protective responses of the host against the biting and salivary molecules. Mosquitoes have evolved to produce biological active substances that directly affect the skin facilitating blood feeding. The immunomodulatory activity of Aedes aegypti saliva on macrophages, dendritic cells and T cells have been extensively studied (Calvo et al., 2011, Calvo et al., 2007, Calvo et al., 2006). Immunomodulatory substances

Cutaneous reactions induced by mosquito bites

The reactions produced by mosquito bites are broad. The typical skin reaction starts as an immediate wheal and flare reaction developing within 15–30 min and delayed papules that may last up to a couple of days (Fostini et al., 2019). Skeeter syndrome is a large local reaction with systemic signs and symptoms such as fever, urticaria and angioedema (Simons and Peng, 1999). Hypersensitivity to mosquito bite (HMB) is a category of Epstein-Barr virus (EBV)-associated natural killer cell

Natural history of mosquito bite hypersensitivity

Mosquito saliva induces immediate (wheals that occur within 20–30 min after the bite) and/or delayed (papules and occasionally vesicules, whisters that appear after 24–36 h after the bite and last several days) skin reactions. Immediate reactions are histaminergic, and the histamine sources may be the mosquito saliva itself (Hassan and Haji, 2014) and the endogenous histamine released during the IgE-dependent immune response elicited against salivary allergens.

Depending on the length and

Mosquito allergens and cross-reactivity

Most of the mosquito body-derived allergens have been identified and characterized from the species Aedes aegypti. It is expected that such allergens are also present in the vast majority of mosquito species since their genes are highly conserved. Saliva-derived allergens include the group 1 (Apyrase) group 2 (Salivary D7 protein), group 3 (Undefined 30 kDa salivary protein) and group 4 (α-glucosidase) (Peng and Simons, 2004). Body-derived allergens are the group 5 (Sarcoplasmic Ca+ (EF-hand)

Considerations for the management of mosquito allergy

Clinical research to find therapeutic alternatives to treat PU has been performed, but to date, prevention and management of the allergic symptoms are still the alternatives with better outcomes for the patients (Ruiz-Maldonado and Tamayo, 1973). For prevention, environmental control, such as the use of bed nets and insect repellents are the most effective strategies (Halpert et al., 2017). Environmental measures to reduce or avoid exposure to mosquitoes involve avoiding infested habitats,

Concluding remarks

The immunological process of mosquito allergy is a complex, barely known process, and may follow different pathways which may depend on the routes of exposure and geographical distribution. It remains to be determined whether the genetic human background, the mosquito species and mosquito-derived antigenic molecules also control the allergic response elicited by mosquito allergens. Depending on the conditions under which the sensitization process, and subsequent exposures to mosquito allergens

Fundings

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of Interest

JFC is an employe at the company Inmunotek, S.L. EFC was an employe at the company Inmunotek. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgements

We would like to thank Sandra Sivill for helping with the manuscript edition and the design and generation of figures.

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