title: Causes of ant sting anaphylaxis in Australia: the Australian Ant Venom Allergy Study.
abstract: OBJECTIVE
  To determine the Australian native ant species associated with ant sting anaphylaxis, geographical distribution of allergic reactions, and feasibility of diagnostic venom-specific IgE (sIgE) testing.
  
  
  METHODS
  Descriptive clinical, entomological and immunological study of Australians with a history of ant sting anaphylaxis, recruited in 2006-2007 through media exposure and referrals from allergy practices and emergency physicians nationwide. We interviewed participants, collected entomological specimens, prepared reference venom extracts, and conducted serum sIgE testing against ant venom panels relevant to the species found in each geographical region.
  
  
  METHODS
  Reaction causation attributed using a combination of ant identification and sIgE testing.
  
  
  RESULTS
  376 participants reported 735 systemic reactions. Of 299 participants for whom a cause was determined, 265 (89%; 95% CI, 84%-92%) had reacted clinically to Myrmecia species and 34 (11%; 95% CI, 8%-16%) to green-head ant (Rhytidoponera metallica). Of those with reactions to Myrmecia species, 176 reacted to jack jumper ant (Myrmecia pilosula species complex), 18 to other jumper ants (15 to Myrmecia nigrocincta, three to Myrmecia ludlowi) and 56 to a variety of bulldog ants, with some participants reacting to more than one type of bulldog ant. Variable serological cross-reactivity between bulldog ant species was observed, and sera from patients with bulldog ant allergy were all positive to one or more venoms extracted from Myrmecia forficata, Myrmecia pyriformis and Myrmecia nigriceps.
  
  
  CONCLUSIONS
  Four main groups of Australian ants cause anaphylaxis. Serum sIgE testing enhances the accuracy of diagnosis and is a prerequisite for administering species-specific venom immunotherapy.
authors.affiliation: Western Australian Institute for Medical Research, University of Western Australia, Perth, WA, Australia. simon.brown@uwa.edu.au
authors.forename: Simon G A
authors.initials: SG
authors.lastname: Brown
authors.forename: Pauline
authors.initials: P
authors.lastname: van Eeden
authors.forename: Michael D
authors.initials: MD
authors.lastname: Wiese
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Mullins
authors.forename: Graham O
authors.initials: GO
authors.lastname: Solley
authors.forename: Robert
authors.initials: R
authors.lastname: Puy
authors.forename: Robert W
authors.initials: RW
authors.lastname: Taylor
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Heddle
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000209:etiology*; D000818:Animals; D000862:Ant Venoms / Q000037:antagonists & inhibitors; D000997:Antivenins / Q000627:therapeutic use; D001000:Ants; D001315:Australia; D005260:Female; D006801:Humans; D007299:Insect Bites and Stings / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D008297:Male; D008875:Middle Aged
chemical_list: D000862:Ant Venoms; D000997:Antivenins