title: Facial angioedema in children due to ladybug (Harmonia axyridis) contact: 2 case reports.
abstract: BACKGROUND
  Only 9 adult cases of immediate-hypersensitivity reaction to ladybugs, also known as Asian lady beetles (Harmonia axyridis), have been documented in the literature. These patients have all shown symptoms of allergic rhinoconjunctivitis or asthma from exposure to ladybugs.
  
  
  OBJECTIVE
  To describe the first pediatric patients with severe allergic facial angioedema requiring emergency department management after exposure to ladybugs.
  
  
  METHODS
  Evidence of IgE-mediated hypersensitivity to ladybugs was documented by positive skin prick test reactions, correlating with exposure history.
  
  
  RESULTS
  Two cases in preschool boys had similar features, although they were evaluated and tested by 2 different allergists. Both patients developed severe facial or periocular angioedema with no significant respiratory involvement after exposure to ladybugs outside their infested homes. Both patients required an emergency department visit for treatment. Allergy evaluation using ladybug extract for skin prick testing showed markedly positive reactions in both patients. There were no further episodes after environmental control measures were instituted.
  
  
  CONCLUSIONS
  Although allergic respiratory or cutaneous reactions to ladybugs are uncommon, a high index of suspicion from exposure history and confirmatory skin testing can be conclusive for the diagnosis.
authors.affiliation: Division of Allergy and Pulmonary Medicine, Department of Pediatrics, St Louis Children's Hospital, Washington University School of Medicine, and Allergy Consultants PC, St Louis, Missouri, USA. ahchu1@aol.com
authors.forename: Ray S
authors.initials: RS
authors.lastname: Davis
authors.forename: Mark L
authors.initials: ML
authors.lastname: Vandewalker
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Hutcheson
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Slavin
mesh_terms: D000799:Angioedema / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D000818:Animals; D002675:Child, Preschool; D001517:Coleoptera; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D004632:Emergency Medical Services; D005148:Facial Dermatoses / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D006801:Humans; D008297:Male