Los alergólogos recuerdan que la mortalidad por picaduras de avispas y abejas es baja
La importancia de la consulta con el especialista
La consulta con el alergólogo después de haber sufrido una reacción alérgica por picadura de himenópteros es fundamental y una tercera parte de los pacientes no acude. “El 60% de los pacientes que han sufrido una reacción alérgica generalizada (anafilaxia) por picadura de avispas o abejas, sufrirán una reacción similar o más grave con la siguiente picadura”, añade la doctora. Por este motivo, la SEAIC aconseja que cuando un sujeto experimenta una reacción local importante, y sobre todo si sufre una reacción generalizada tras la picadura de uno de estos insectos, solicite a su médico de cabecera que le remita a un servicio de alergia hospitalario para su evaluación, donde se le someterá a pruebas diagnósticas, y se le pautará tratamiento con inmunoterapia en caso de estar indicado.
Las picaduras de avispas y abejas se disparan durante los meses cálidos, cuando estos insectos están activos y se hace más vida al aire libre. Las reacciones suelen ser locales, con picor, enrojecimiento e inflamación circunscrita a la zona donde pica el insecto, pero cuando el área de inflamación es mayor de 10 cm. de diámetro nos encontramos ante una reacción alérgica que se considera patológica. En algunos casos se producen lesiones en la piel a distancia del lugar de la picadura, dificultad para respirar, mareo o síntomas digestivos, lo que constituye una reacción alérgica generalizada grave o anafilaxia que debe ser atendida de forma urgente.
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El Comité de Alergia a Himenópteros ha presentado recientemente un estudio que identifica véspidos (avispas) en entornos de alimentos de consumo humano. “Los diferentes hábitos de alimentación de las avispas pueden ayudar a identificar mejor la especie de insecto que ha picado a la persona. Saberlo es un apoyo importante al diagnóstico que puede llegar a evitar pruebas complejas y costosas”, explica la alergóloga.
Después de analizar más de 100 imágenes correspondientes a 50 insectos enviadas por alergólogos de todo el país e identificadas por el entomólogo experto Leopoldo Castro, se encontró que la avispa del género véspula (avispa común) fue el himenóptero relacionado en el 74% de los casos con ambientes en los que había carne, pescado y marisco. La siguiente especie más presente fue la vespa (avispón) de la que se encontraron 4 casos de Vespa velutina y 1 de Vespa crabro, todos ellos en el noroeste del país. También se identificaron avispas del género polistes (avispa papelera). Todas estas aparecieron en ambientes relacionados con alimentos ricos en carbohidratos como bebidas alcohólicas, bebidas azucaradas, frutas y dulces.
Este trabajo ha sido premiado por la Academia Europea de Alergia e Inmunología Clínica (EAACI) como “Mejor Comunicación Poster” en el Allergy School on Insect Venom Allergy and Mastocytosis celebrado del 11 al 13 de abril en Groningen.
Tratamiento urgente y tratamiento curativo
La vacunación con veneno de himenópteros es probablemente la forma de inmunoterapia más eficaz. “El tratamiento para los pacientes que ya han sido diagnosticados de alergia al veneno de avispas o de abejas es muy efectivo. Se realiza con el veneno del insecto responsable de la reacción alérgica y consigue que el paciente tratado deje de ser alérgico y no presente ninguna reacción en caso de una nueva picadura”, subraya la doctora Ruiz. “Su efectividad, superior al 90%, está probada mediante la repicadura con el insecto, que puede ser espontánea (accidental) o bien de forma controlada en el hospital. Esta eficacia se alcanza rápidamente tras llegar a una dosis de mantenimiento mínima de 100 mg, aunque para consolidar esta respuesta de tolerancia hay que administrar el tratamiento en dosis mensuales o cada dos meses durante aproximadamente 5 años”.
Los pacientes con antecedentes de reacción alérgica generalizada grave (anafilaxia) por veneno de himenópteros o por otras causas deben ser instruidos en la autoadministración de adrenalina, el tratamiento de emergencia de las reacciones anafilácticas.
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