How to Know if You Are Allergic to Mosquito Bites

Summer means the welcome return of warmer weather but the unwelcome return of mosquitoes and bites, too. For some, mosquitoes are more than a mere nuisance, causing severe allergic reactions. Read on to learn about mosquitos, their bites, and how to relieve the symptoms. You'll know how to spot the danger signs of an allergy and when a bite might need a doctor's visit.

What is a normal mosquito bite reaction?

A normal mosquito bite progresses in stages. In the first 20–30 minutes, you might notice a wheal — a small, rounded bump less than a centimeter wide surrounded by red, inflamed skin. Over the next 24–36 hours, a delayed reaction may occur, with an itchy, firm bump that gradually fades over the next few days.

The body’s response to mosquito bites can evolve over time. The first bite might only leave a red spot, but later bites can trigger varied reactions, potentially leading to natural desensitization. However, others experience large local reactions signaling a potential mosquito bite allergy.

Why do mosquito bites itch?

The itch from mosquito bites has been linked to mosquito saliva, which contains a cocktail of compounds such as histamines that trigger itching. Experiments have shown that when the salivary gland of a mosquito is cut, the bite no longer itches.

Research suggests that women may experience more severe reactions than men, possibly due to genetic factors.

What is an abnormal mosquito bite reaction?

While most mosquito bites result in short-lived irritation, some experience symptoms that are anything but typical. Understanding these reactions is crucial, as they can be signs of an allergy or a heightened immune response to mosquito saliva.

Who is at risk of an allergic reaction to mosquito bites?

Certain groups are more likely to have an allergic reaction. These include:

High exposure individuals

People who spend a lot of time outdoors for work or leisure, such as military personnel or construction workers, face a greater number of bites, increasing the risk of developing an allergic reaction.

Travelers and new residents

Immigrants and travelers who encounter new mosquito species may not have developed immunity, leaving them more vulnerable to an allergic reaction.

Infants and young children

With their immune systems still developing, young children may not have a natural resistance to antigens in mosquito saliva, making them prone to severe reactions, including Skeeter syndrome.

Skeeter syndrome

More intense reactions can range from urticaria (hives), which presents as clusters of itchy welts, to Skeeter syndrome — a severe response beyond the usual swelling and redness.

Common symptoms of Skeeter syndrome include an itchy, sometimes painful area of redness, warmth, and swelling ranging from a few cm to over 10 cm wide. These develop within hours, peaking at 8–12 hours or more, and resolve within 3–10 days.

Depending on where the bite is, symptoms can interfere with seeing, eating, drinking, or using limbs. More severe large local reactions may be accompanied by low-grade fever and general malaise.

People with immune deficiency

Patients with certain blood cancers or HIV are also known to have hypersensitive responses to mosquito bites. These individuals may develop widespread itchy red bumps on the skin, which are linked to immune system dysfunction.

People with HEN disease

A rare condition known as HMB-EBV-NK disease (HEN disease) is linked to an overreaction to mosquito bites in the presence of EBV (monovirus) infection. This can lead to severe symptoms like blisters, ulcers, or even tissue death at the bite site.

Signs of a mosquito bite allergy

Systemic allergic reactions to mosquito bites include hives and, rarely, asthma symptoms, anaphylaxis, lymphadenopathy, fever, and necrotic skin reactions at bite sites.

• Large area of swelling. A significant swelling around the bite site can be a sign of an allergic reaction, especially if it extends far beyond the bump typically seen.
• Excessive redness. While some redness is normal, a vivid and extensive area of more than a few centimeters may indicate an allergic reaction.
• Hives. The appearance of raised, itchy welts on the skin, known as hives or urticaria, may be an allergic reaction to mosquito saliva.
• Bruising. Uncommon in normal bite reactions, bruising around the bite site could signify an allergy.
• Blistering. Mosquito bites usually don't blister; if they do, it's usually a sign of an abnormal reaction.
• Fever and fatigue. Systemic symptoms like fever and general tiredness following a bite may point to an allergic response.
• Swollen lymph nodes. Lymph nodes around the bite may swell as part of the immune response.
• Asthmatic symptoms. Difficulty breathing or wheezing post-bite can indicate a serious allergic reaction and requires urgent medical attention.
• Anaphylaxis. A rare but severe potentially life-threatening reaction characterized by rapid onset of wheezing, swelling, rash, faintness, and breathing difficulties.

If you notice any of these symptoms, consult a healthcare provider, especially if they're accompanied by systemic issues like urticaria, asthma, or anaphylaxis. While rare, these reactions require prompt medical attention.

Treatment for mosquito bite allergy

Mosquito bites are mostly a nuisance, but for some, they can trigger significant allergic reactions. Here’s an overview of the treatment options, ranging from natural remedies to medical interventions.

Natural and homemade remedies for mosquito bites

For those seeking a gentler approach, certain natural and homeopathic remedies may offer relief, though it's important to note that robust supporting evidence is limited.

Calamine lotion may provide immediate relief for a range of insect bites. Other homeopathic tinctures like Echinacea angustifolia have been traditionally used to alleviate symptoms.

Oat-based products, such as oatmeal paste, may provide some relief as oats are known to have anti-inflammatory and anti-irritant properties.

The CDC advises making a paste out of baking soda and water and leaving it on the mosquito bite for 10 minutes.

Over-the-counter medicines

For more pronounced local reactions, over-the-counter antihistamines like levocetirizine, cetirizine, and loratadine are backed by studies demonstrating their efficacy in reducing wheal size and itchiness.

They work best when taken as a prophylactic and help with both immediate and delayed allergic responses. It’s worth noting that while cetirizine may be highly effective, it may also lead to sedation. As of now, other antihistamines like ebastine and rupatadine, despite showing promise, aren’t approved in the United States.

Prescription medicines

While antihistamines have mixed results in managing delayed reactions, topical steroids, which target inflammatory pathways, are often recommended by healthcare professionals.

However, they haven’t been tested in clinical trials for mosquito bites, and more research is needed. In the rare instances of severe local or systemic mosquito bite reactions, oral steroids may also be indicated, as they are for other skin reactions.

Seeking medical help

If you experience symptoms such as high fever or blistering, seek medical advice. Health professionals can offer treatments, such as prescription medications or allergy testing, and guide you on how to manage severe allergic reactions safely.

If you believe you have any signs of anaphylaxis, including throat swelling, wheezing, difficulty breathing, or faintness, go to an emergency room or call emergency services.

How to test for mosquito allergy

Mosquito bites can cause allergic reactions due to the saliva that female mosquitos introduce into the skin when they bite. Allergy testing is done to identify any immune reaction to the proteins in mosquito saliva or on their bodies.

Clinical history and physical examination

Generally, a diagnosis of mosquito allergy is made through a thorough patient history and physical examination. Your provider will gather information about past reactions to insect bites, the frequency and severity of symptoms, and any patterns or triggers.

A physical will involve searching for characteristic signs of allergic reactions to mosquito bites, such as hives or blistering, and any evidence of secondary skin infections from scratching.

Skin prick testing

Mosquito allergen extracts for skin testing are available but aren’t considered central to evaluation. This is partly because these tests contain a mixture of antigens that differ from the specific salivary proteins responsible for mosquito bite allergies. These tests aren’t very accurate, and commercially available skin prick tests only detect 30–50% of children with mosquito allergies.

More precise testing methods like mosquito saliva extracts are more accurate, but obtaining mosquito saliva is challenging, limiting widespread use.

Immunological testing

To aid in diagnosis, tests can be conducted to detect antibody sensitization. However, distinguishing mosquito bite reactions from those caused by other insects is crucial, as many insects can provoke similar responses.

Identifying specific antibodies IgE may help confirm an allergy and assist in helping to avoid particular insects. However, there's not enough evidence to support the reliability of these tests.

How to prevent mosquito bites

Prevention is better than cure, and there are multiple strategies to stop these pests from leaving their mark.

Use mosquito repellents

To safeguard against mosquito bites, repellents are highly recommended. Repellents can be divided into chemical or organic categories, both of which can be used on the skin or clothing.

Chemical Repellent, N,N-diethyl-3-methyl-benzamide (DEET), is a potent repellent that effectively prevents mosquitos from biting. While DEET is safe for most users, concentrated products, over-inhalation, or ingestion can be toxic.

Organic and botanical repellents

Due to their lower toxicity, more pleasant scent, and environmental friendliness, botanicals and essential oil-based repellents are becoming more popular. One such non-toxic alternative to traditional chemical repellents is Picaridin, which is extracted from pepper plants. Other examples include citronella, peppermint, eucalyptus, and lemongrass.

Wear protective clothing

Dressing in clothing that covers as much skin as possible is an effective barrier against mosquito bites. Long sleeves, pants, and socks are advisable, particularly in areas with high mosquito populations or during activities such as hiking or camping.

Avoid peak mosquito times

Mosquitoes are most active during dawn and dusk when the air is cooler and less windy. Planning outdoor activities outside these times can reduce the chances of being bitten.

Use fans

Outdoor and indoor fans can keep you cool and deter mosquitoes. The wind generated by fans can make it difficult for mosquitoes to fly and land on you.

Use mosquito traps

Mosquito traps lure, trap, and kill mosquitoes, reducing their number in your immediate environment. These can be particularly useful in outdoor living spaces.

Use indoor protection

When indoors, it is important to use protective measures, such as mosquito nets, especially over beds, and ensure windows are fitted with screens to keep mosquitoes out.

Understanding mosquito bite reactions is key to recognizing allergies and taking appropriate actions. From prevention to treatment, awareness and timely care can mitigate risks and provide relief from these common yet troublesome insect encounters.