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Bumps & Bites: Protecting Yourself Against Pests, Plants


By Mark Oswell

WRNMMC Command Communications

After a day outdoors, you reach down to scratch an itch on your leg and notice a red bump.

Mosquito bite? Tick? Poison ivy?

Summer brings not only hot muggy days to the Mid-Atlantic region, but also a litany of bumps and bites ranging from ticks to jellyfish stings.

“Some of the more common pests include mosquitos, hymenoptera (wasp, bee, hornet, yellow jacket, fire ant), ticks, blackflies, sandflies, and mites (or chiggers),” according to Navy Lt. Cmdr. (Dr.) Diana Lindsey, Walter Reed National Military Medical Center allergist/immunology fellow.

“Unfortunately, you cannot always identify what type of bug has bitten you,” according to Army Capt. (Dr.) Casey Chern, WRNMMC staff dermatologist. In the United States, it’s common to experience a bite or sting from mosquitoes, fleas, bedbugs, mites, spiders, ticks, fire ants, bees, wasps and hornets.

“Most bug bites and stings can be safely treated at home with topical medication, such as hydrocortisone cream or ointment, or an oral antihistamine to reduce the itch,” explained Chern. “However, sometimes a bug bite or sting could turn into something serious, particularly if you have been bitten or stung by many insects at the same time.”

Bed bugs - Summer trips to new places or familiar haunts are a staple for many people. As such, they sleep in unfamiliar places – a tent, a hotel bed, a friend’s guest room, etc. And while most of these places are free and clear of creepy crawlies, bed bugs remain an issue nationwide. Last year, numerous news articles noted an uptick in bed bug incidents.

“Bed bug bites may be more prevalent in the summer,” explained Army Maj. (Dr.) Martin Evans, Walter Reed Bethesda staff allergist/immunology fellow. “It is not clear that bed bugs are dormant in winter or whether people are more likely to travel in summer. It does appear that people are more likely to receive bites in the summer.”

According to the Federal Trade Commission, bed bugs are visible to the naked eye, but often hide in cracks and crevices. Other signs of bed bugs are small dark spots and rusty or reddish stains on bed sheets or mattresses caused by bed bugs being crushed.

The FTC recommends the best ways to prevent bed infestation while traveling are:

     • Use luggage racks to hold your suitcases when packing and unpacking

     • Check the mattress and headboard before getting into bed

     • When you get home, unpack directly into a washing machine, and wash and dry on the highest temperature setting

     • Inspect and then vacuum all luggage, and empty the vacuum outside

More information can be found at: https://www.ncbi.nlm.nih.gov/pubmed/?term=Seasonal+variability+in+bed-bug

Chiggers - Although not poisonous, the bite from these mite larvae are known to create severe itching and hives. The primary treatment for the itching is through the use of antihistamines and corticosteroid creams or lotions, according to the National Institutes of Health’s U.S. National Library of Medicine.

Heat Rash (aka Pric​​kly Heat) – According to Chern, heat rashes are caused by blocked sweat glands. “Because the sweat cannot get out, it builds up under your skin, causing a rash and tiny, itchy bumps. When the bumps burst and release sweat, many people feel a prickly sensation on their skin.”

“Anything you can do to stop sweating profusely will help reduce your risk,” said Chern.

Tips to help sweat less and decrease the risk of getting prickly heat include: wearing light-weight, loose-fitting clothes made of cotton; exercising outdoors during the coolest parts of the day or moving your workout indoors where you can be in air-conditioning; and keeping your skin cool by using fans, cool showers or air-conditioning when possible.

Imported fire ants - Although typically seen in the South, imported fire ants are an invasive species that have recently crossed the Potomac into Maryland.

According to the NIH’s National Institute for Occupational Safety and Health, “Fire ants bite and sting. They are aggressive when stinging and inject venom, which causes a burning sensation. Red bumps form at the sting, and within a day or two they become white fluid-filled pustules.”

Immediate medical care is to rub off ants briskly, as they will attach to the skin with their jaws. Antihistamines may help those with mild symptoms, but injectable epinephrine might be necessary for severe allergic reactions. If the sting causes severe chest pain, nausea, severe sweating, loss of breath, serious swelling, or slurred speech – take the victim to an emergency medical facility immediately.

Jellyfish - There are more than 2,000 types of jellyfish found in the world, with approximately 70 being harmful to humans. Jellyfish tentacles can still sting even after they have washed up onto shore. According to the Smithsonian Institute, jellyfish have special cells along their tentacles called cnidocytes. Within these cells are harpoon-like structures full of venom, called nematocysts which shoot out when triggered by touch and can penetrate human skin.

Although there’s a myth about urine relieving jellyfish stings, that not the case. Pouring freshwater—including urine—on the area will change the composition of the solution surrounding the remaining cells and may actually trigger the release of more nematocysts and venom.

Jellyfish sting management will vary according to the severity of symptoms and can include medications, such as diphenhydramine, steroids, pain medication, and antibiotics, according to the Centers for Disease Control and Prevention.

Ticks - According to the CDC, Americans will get more tick bites and tick-borne diseases between May and July than any other time of year. And while each year, more than 30,000 new cases of Lyme disease are reported, ticks are also carrying more diseases. Ticks flourish during summer months with more warm-blooded humans venturing into the woods and parks.

“Reported cases of tick-borne disease have doubled in the 13-year analysis period, with Lyme disease accounting for 82 percent of cumulative reported tick-borne disease,” explained Chern. “The combined incidence of reported anaplasmosis and ehrlichiosis, which are tick-borne bacterial diseases, rose almost every year, as did spotted fever; babesiosis, a tick-borne parasitic infection that has been notifiable since 2011.”

To avoid being bitten by a tick, the U.S. Forest Service recommends wearing long pants and long-sleeved shirts, staying out of tall grass and checking for ticks immediately after being outdoors. Additional tick prevention and removal advice can be found at: https://www.fs.usda.gov/detail/superior/learning/safety-ethics/?cid=FSEPRD538490

Poisonous plants – The genus Toxicodendron includes poison ivy, poison oak and poison sumac, all of which produce a clear liquid compound called urushiol.

Contrary to popular belief, the rash will occur only where the plant oil has touched the skin, so a person with poison ivy can’t spread it on the body by scratching, according to the U.S. Food and Drug Administration’s website. It may seem like the rash is spreading if it appears over time instead of all at once, but this is either because the plant oil is absorbed at different rates on different parts of the body or because of repeated exposure to contaminated objects or plant oil trapped under the fingernails. Even if blisters break, the fluid in the blisters is not plant oil and cannot further spread the rash.

The FDA recommends that if you do come into contact with one of these poisonous plants to wash your skin in soap and cool water as soon as possible if you come in contact with a poisonous plant. And not to scratch the blisters as bacteria from under your fingernails can get into them and cause an infection.

To relieve the itching from urushiol, the FDA / CDC and others recommend using a wet compresses or soaking in cool water; applying over-the-counter topical corticosteroid preparations or taking prescription oral corticosteroids. Applying topical OTC skin protectants, such as zinc acetate, zinc carbonate, zinc oxide, and calamine dry the oozing and weeping of poison ivy, poison oak, and poison sumac can also be beneficial. Protectants such as baking soda or colloidal oatmeal relieve minor irritation and itching. Aluminum acetate is an astringent that relieves rash.

Vespidaes – Paper wasps, European hornets and Yellow jackets are just a few of the vespids found in the Mid-Atlantic region. These brightly-colored flying insect are known perpetrator of numerous stings throughout the summer months.

“The vast majority of people are not at risk for life-threatening allergic reactions from insect stings,” according to Evans. Most commonly people will have a local reaction. Typically, an area of redness and painful swelling at the site of the sting develops. This may resolve in hours or occasionally over a few days. Uncomplicated local reactions may be treated with cold compresses.

However, he explained that people with a history of anaphylaxis to bee/wasp/hornet stings should carry injectable epinephrine with them at all times and inject themselves with epinephrine at the first sign of anaphylaxis.​​

If no epinephrine injector is available, direct the affected person to lay down with feet elevated, keep their mouth free of debris, and call 9-1-1. Try an over-the-counter antihistamine until emergency medical care arrives, according to Lindsey.​​