Antihistamine Use for Insect Bites

[Ernest2]

I thought it was about time I posted, and first explain I’m on the home straight of my journey through the 7 year FLAIR trial, with my last review due this December, and I’m still in good remission (I’m in the FCR Chemoimmunotherapy arm of the trial) . . .

I’ve found out in the last two years that I’ve got suspect Polygenic Hypercholesterolaemia so now happily taking a Statin each day (Do get your cholesterol rechecked, funny things can happen).

Now in the last month I seem to find I now have an issue with insect bites (and not the ones a few years ago that fooled me into thinking I had a shingles attack . . .)

There do seem to be lots of good posts on HU for insect bites (many thanks to all for those) e.g.

healthunlocked.com/cllsuppo...

Now I’ve absolutely no idea what has been biting me, nor where it happened. The first set of bites on the hands over several days, perhaps from watering the garden at dusk (bad move), gave me pain for two weeks in each case.

Then I got a bite on the ankle. This happened during 2 days of recent heatwave (perhaps) either:

a)At a local stately home where I usually sit each year for annual picnic

b)Cycling round a local reservoir (trying to improve the circulation in my legs)

c)Gardening at home where there is a pond built many years ago

In each case (with the heatwave) unusually for me, I failed to wear the correct PPE (Long trousers, shirts, gloves when appropriate).

For this latest bite on my ankle I thought no harm to try an Antihistamine cream (on advice from a good friend).

Read all the packet before you do that, and perhaps more.

I now have a one inch diameter blister on my ankle. 10 days later it is still inflated and not thought yet to be infected but full of yellow serous fluid, with a hazy/fuzzy yellow shape in the centre.

I am now many pharmacy visits, x2 111 calls, and x1 GP call wiser.

Why am I now getting bad reactions to bites? I can think of at least four options, singularly or in combination:

a)I’ve been very stupid with PPE and ignorant about antihistamines

b)I’ve unfortunately sensitised myself to the biter, by multiple bites

c)Something to do with my CLL status

d)(Imagination out of control) A particularly nasty fly has taken up residence in my area

For the last option the following is interesting as it covers the area I live (This article dates from last year):

oxfordhealth.nhs.uk/news/mi...

Note the comment there about avoiding topical antihistamines.

The so called “Blandford Fly” is Simulium Posticatum for the dipterists amongst you:

en.wikipedia.org/wiki/Bland...

So what I’ve possibly learned so far. This list is just my experience to date, and most certainly not a guide to bites (Please correct / update me though if you feel this is in error, and if you get into difficulty with bites always consult your medical team first, before taking action):

1.Never take shortcuts on the PPE (I’m normally a complete nerd for PPE) long trousers and shirts, gloves when pruning/watering and use insect repellent spray (I’ve only sprayed the clothes so far, which does not follow the instructions on the tin). If the weather is really too hot for PPE then just “don’t do it”.

2.(I’ve never done this) Wash the bite with soap and water. I always seem to be too late spotting bites. I never feel the actual bite.

3.Do NOT lance the fresh blister, certainly not lance one that is not yet infected. Leave infected bites to the experts. In ignorance (about infection) I tried lancing after a couple of days with a sterilised needle, and rolled out the fluid. The blister was 10 x 15mm at that stage, but simply grew back larger. Luckily I think all I succeeded in doing was to create a safety valve for the blister.

4.Antihistamine creams have poor efficacy(?) and there possibly seem to be some risks(?) so are best avoided(?) unless you already know they work well for you

5.For oral antihistamines go for a second generation one to avoid mind bending side effects of the 1940’s ones. I’m now on second generation 1980’s Loratadine for another week while the blister makes up its mind. Are there better ones?

6.Should we take prophylactic antibiotics for these bites(?) My blister is not yet thought to be infected. Yesterday I got some prescription Flucloxacillin (Your medical team needs to check and approve the particular antibiotic they choose for you. This one may I think only be suitable for some. Always read all the data sheet for whatever you are given.). Think I’ll start taking them this afternoon, as I’m expecting an accidental burst now. The blister is now uncovered as I’m getting into Eczema issues from the bandage tape.

7.Unless you need the protection of hydrocolloid plastic backed stick on bandages, best stick to the conventional old-fashioned type (which still have perforated plastic next to the skin) held on with bandage tape, so you can easily get them off if stuck by careful douse with fresh saline after cutting/removing the tape, changing the bandage each 2 days (Ask what your team recommends for you)

8.I really don’t know how to avoid Eczema from bandage tape, or plasters, if applied for a long period. For tape you can change the pattern from square to St Andrews cross, to St George cross, etc. but eventually you run out of options. So today I’m writing this with the risk of no bandage on, and emollients on the surrounding skin to give it a rest.

9.These insect bite blisters can be much larger than mine. I’ve heard of 4 inch x 2 inch. Remember if feeling depressed about your situation, there are always others in much worse situations. Channel your inner John Sentamu and make the most of what you have every day.

P.S. Last Question: For the pond in the garden at home, if that’s where the critters came from, anybody know about BTI biological controls for home use, or should I fill in the pond one winter (that feels destructive), or move house (tricky).

I’ll update this post with corrections to any errors.

Wishing you all well,

Ernest

[mrsjsmith]

Ernest,

I sympathise as someone who has suffered in varying degrees over many years. I am sure I have tried every medication and home remedy I read about.

Just something else to throw in the mix, but could it be a horse fly bite ?

Hope it clears up soon.

Colette

[Jacksc06 in reply to mrsjsmith]

Could well be a Horse fly bite, They are pretty nasty.

[Ernest2 in reply to Jacksc06]

Hi Jack good to hear from you

Yes I should consider the most likely, and re read about Occam's razor:

en.m.wikipedia.org/wiki/Wil...

This is all new to me. Think I probably sensitised myself by the earlier bites. I never felt any of them at the time or saw the critters.

Best wishes,

Ernest

[Ernest2 in reply to mrsjsmith]

Hi Colette,

Yes it's certainly an option. I was just thinking we'll no horses near where I was. I've never seen a horse on my local bridleway. But then I read they can travel 30 miles

pestworld.org/news-hub/pest...

Now I live about as far from the beach as you can get, but the above seems to indicate that won't help me so my dreams of moving to the coast (only a pipe dream) are blown.

Many thanks

Ernest

[mrsjsmith in reply to Ernest2]

Ernest,

I live in London and my GP said I was the 3rd patient with a horse fly bite that morning.

Thinking back pre treatment my mosquito bites would swell into large blisters. At the time I had a private GP and he would give me an injection, Piriton I think, and that was an amazing treatment.

Have you tried the usual things ? I take Brewers yeast and a strong garlic pill in the summer.

Colette

[Ernest2 in reply to mrsjsmith]

Thanks for that Colette.

Well there are still a few horses in London.

I cook with garlic about three times a week, so need to up the dose then, for the bike in summer.

I did oral Piriton tablets for about three days that turned me into a zombie. The next pharmacy I happened to be in explained they wouldn't sell oral Piriton (1st generation) over liability concerns. The second generation Loratadine I'm still on seems much better. There are others.

I think you can perhaps also get an oral antihistamine with a steroid component. Not sure yet of any names. I think that might perhaps be the best choice.

We need some expert advice on all this.

Thanks,

Ernest

[mrsjsmith in reply to Ernest2]

Agreed Ernest,

My current GP is normally very helpful so will add that to the list of questions, but luckily l haven’t had too many problems recently. Except for the cats and fleas, and despite them having treatment every month I have had a number of bites. Sadly my neighbours have a family in the garden that they feed so I can only assume that’s where they are getting them from. The foxes in London are brazen and just wander the streets during the day.

Colette

[Justasheet1]

Ern,

The exaggerated reaction to insect bites are from your CLL.

My doc at MDA has prescribed me prednisone tablets to be taken for 3 days. They help.

The topical benedryl spray and cortisone cream doesn’t do much. The itching gets much worse at night.

If I’m bitten on the ankles, I always blister; no where else. I had a blister much like yours but was 2” by 2”. I went to the ER as the itching was horrible and they did nothing.

I eventually lanced and drained it against my better judgment and the itching was relieved. When I got bit on the other ankle, I lanced it before it got huge and did great. I used sterile needles and a betadine scrub.

Now, I don’t go outside without tall boots and a mosquito suit. It looks ridiculous but it works.

I live in the woods and so far that is the solution as even with Deet, they get me.

Jeff

[Ernest2 in reply to Justasheet1]

Big thanks for all that Jeff, so oral steroids probably the next thing on the list to ask about.

I have happily given up worrying what I look like a long time ago so any change of dress is no issue for me.

Cycling outdoors in warm weather is perhaps one remaining problem area, but I'll try some experiments with clothing (guess next summer now). Funnily I did read in a cycling article a few weeks previous "never ever wear short socks". It didn't say why but it's cristal clear to me now LOL.

Best wishes,

Ernest

[Ernest2 in reply to Justasheet1]

Hi Jeff,

I've just managed to see my GP to discuss insect bites, and I did raise the oral corticosteroids question. The UK thinking was that the side effects would be too severe. I note though that your MDA prescription for Prednisone was just three days, that sounds sensible. Can I ask then how bad the side effects were in your case? (OK we are all very different so its not a take away for anyone without discussing with their clinical team)

Interestingly I remember my father a CLL patient in the 1980's took these kind of steroids I think as part of CLL treatment at that time (although I may well confuse Prednisone with Prednisilone) and he had bad side effects with it. I remember the mood swings amongst others, particularly when trying to cut down the dose, once the red cell count had recovered. I'm sure there were other side effects too, but my memory gets hazy.

P.S. I've put BTI in the home garden pond for the mosquito etc. . . . well it makes me feel better. No idea what bit me though as I've seen plenty of mosquito with no ill effects in other places. Jack's guess of a horse fly may be the best, I wouldn't rule out also the smaller Simulium Posticatum as its supposedly in our area these days.

Many thanks,

Ernest

[Justasheet1 in reply to Ernest2]

Ern,The only side effect for me is difficulty sleeping if taken near bedtime.

10mg taken once daily is a really low dose and for only three days. Harmful side effects are from much much larger doses and for longer periods of time.

Jeff

[Ernest2 in reply to Justasheet1]

Many thanks Jeff for that.

[cllady01 Former Volunteer]

The larvae of mosquito live and grow in standing water. With a way to have the water moving--fountain, you can get some help. The following (if you have mosquitos in Britain)is a way to kill the larvae of the insects in standing water:

duckduckgo.com/?q=Mosquito+...

[Ernest2 in reply to cllady01]

Many thanks CLLady. I've seen those but wasn't sure, so I'll give them a try. Probably good from a mental point if view otherwise the garden will terrify me.

Best wishes,

Ernest

[Ernest2 in reply to cllady01]

Got a six pack of those now. One bobbing in the pond now and a shaving in the water trough.

Many thanks,

Ernest

[cllady01 Former Volunteer]

entomology.ca.uky.edu/ef017

there are more than mosquito larvae in standing water--so here is a rundown that might help you identify what you might be dealing with---University of Kentucky.

Here is difference in Mosquito and Midge, which is a UK native--some are biters and carry diseases. Some Mosquitos carry diseases also.

lakeandwetland.com/midges-v...

While, the above are US sites, the two insects are similar, so thought it interesting to look at both and the dangers of their bites. I will no stop this interesting study.

Midge bites usually hurt much more than a mosquito bite. You’ll feel it but not know what is biting you because they are so small you can’t see them. Eventually, their bites will turn into welts up to two inches in diameter.

[Ernest2 in reply to cllady01]

I never felt any of the three bites on the hands nor the blistered one on the ankle, at the time of the bite. I do have some nerve damage in the lower legs though.

Please keep up the study. I have a feeling this is going to get more important.

[cllady01 Former Volunteer in reply to Ernest2]

The midge bite sounds similar to your experience--size and blistering.

[Ernest2 in reply to cllady01]

In my mind it wasn't a very small fly as I've always walked past lots without a problem (and a fair few today). However I think there are lots of different varieties. I won't get hung up on what it was, just concentrate on the PPE and getting my current bite to heal once it's burst.

Many thanks.

[Kwenda]

As someone who visits Blandford Forum regularly I can say that the local population takes the matter seriously and monitors the local river Stour. I myself was bitten on the ankle by an unknown insect and was immobile for a while due to the pain of walking.

I DO CONFIRM that Flucloxacillin, when finally used, did successfully clear up the infection quite rapidly.

Dick

[Ernest2 in reply to Kwenda]

Great to hear from you Dick, and admiration for your bravery to visit the Forum. I'm terrified of my back garden just at the moment.

As yet the blister is intact and the experts think not infected.

However as everyone thinks it must now burst anytime soon, I've started taking the antibiotics yesterday.

I am now reading all drug data sheets fully and checking online for drug interactions.

Best wishes,

Ernest

[claree_ford]

Hi Ernest, I do hope it clears up soon without further problems.I discovered a few years ago (well before cll) that, bizarrely enough, I am allergic to anti histamine creams. It started with an unpleasant insect bite on my ankle which my then mother-in-law suggested I put cream on. The result was everyone assumed I’d been bitten by a snake. Next bite the same thing happened. I was suspicious and put the cream on an unbitten area. Up it came... personally I have no problems with tablets but I can certainly echo your “be careful with creams”. Get well soon.

[Ernest2 in reply to claree_ford]

Many thanks Clare. Well done for sorting your issue. I think the creams may work for some in certain scenarios but perhaps need clearer warnings on them and not be freely available. It does seem odd you can take something orally that upsets if put on your skin.

Best wishes,

Ernest

[Psmithuk]

When I worked in the hospital I was told that anti-histamine cream caused more problems than it solved by a dermatologist - just a warning to others!

[Ernest2 in reply to Psmithuk]

Many thanks for that.

I have to confess at this point I have done a "yellow card" on the cream to see if there is any useful feedback. To me the warnings on the packet are too small print, also should there be a warning not to use if you don't know what you have been bitten by(?) A suggestion to buy tablets instead would also help.

yellowcard.mhra.gov.uk/

[blowinginthewind]

Hi Ernest,

I had an insect bite on my lower leg become infected and give me sepsis - 3 years before diagnosis but CLL was probably around.

`i tend to get small cuts and puncture wounds on my hands as well - I was involved in an accident 20 odd years ago and I have very little feeling in my hands. I I now have, available prescription only, a tube of Fudcidin aka Fucidic Acid aka Fucithalmic cream in my cupboard and I use it as soon as I find something like a bite or pulled skin around a finger nail or anything else. It last for several years, and I rarely use a whole tube before it expires, and it works well. I am allergic to antihistamine by the way - at least oral antihistamine. Daughter is allergic to the cream they put drugs in - she has to have an ointment instead.

I hope you get your bite sorted soon, it is worth asking for the cream from your GP, and having it in ready for when you need it.

Liz P

[Ernest2 in reply to blowinginthewind]

Thanks Liz.

That's all intestine. In a bid to treat Eczema on my legs I have done prescription creams with steroid and Fusidic acid. They didn't help for the Eczema but I can believe in the right application might do the job.

I've got some nerve damage in my feet, and Reunauds. Also got a test coming up to check the circulation in my legs. The blister may take precedence though LOL

Best wishes,

Ernest