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ORIGINAL RESEARCH article
Front. Allergy
Sec. Drug, Venom & Anaphylaxis
Volume 6 - 2025 | doi: 10.3389/falgy.2025.1570123
Fire ant venom anaphylaxis prevalence in the general population and patients with systemic mastocytosis
Provisionally accepted
Jeremy Clay McMurray1*
Brandon J Schornack1
Karla E Adams2
Robert L Mccoy1
Amanda K Marshall3Janet A Brunader3
Irina Maric4Dean D Metcalfe4
Nathan A Boggs1,5- 1Walter Reed National Military Medical Center, Bethesda, United States
- 2Wilford Hall Medical Center, San Antonio, Texas, United States
- 3Defense Health Agency (DHA), Silver Spring, Maryland, United States
- 4National Institutes of Health (NIH), Bethesda, Maryland, United States
- 5Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Illinois, United States
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Background: Stinging Hymenoptera can induce fatal anaphylaxis, especially in patients with systemic mastocytosis. Fire ants, Solenopsis invicta and S. richteri, from South America have recently colonized three continents. Prevalence of fire ant-venom anaphylaxis in the general population and in systemic mastocytosis is unknown. The aim was to determine fire ant-venom anaphylaxis prevalence among Tricare beneficiaries and those with systemic mastocytosis.Methods: We queried the beneficiary immunotherapy prescription database for patients who received immunotherapy with Hymenoptera venom or fire ant whole-body extract and the Tricare beneficiary population health registry database for patients with an ICD-10 code for Hymenoptera venom allergy (HVA). Greater than 95% of the beneficiary population were patients living in the United States. Chart review of a random sample of 150 patients linked to a HVA ICD-10 code was performed to determine the percent of patients with Hymenoptera-venom anaphylaxis. Retrospective review of a systemic mastocytosis cohort was performed to assess fire ant-venom anaphylaxis rate and treatment patterns.Results: Fire ant immunotherapy was the most frequently ordered individual immunotherapy prescription 45.9% (n=878). Fire ant prescriptions surpassed all flying Hymenoptera immunotherapy prescriptions combined in six states. Fire ant and flying Hymenoptera-venom anaphylaxis prevalence in the general population was 0.048% and 0.083%, respectively. Fire ant-venom anaphylaxis prevalence in the 14 colonized states was 0.085%. More patients with systemic mastocytosis had anaphylaxis triggered by fire ant than all Hymenoptera combined. Conclusion: Fire ant-venom anaphylaxis prevalence in the general population and patients with systemic mastocytosis is higher than all flying Hymenoptera-venom anaphylaxis combined in colonized states. Fire ant-venom anaphylaxis in systemic mastocytosis is frequently misdiagnosed and not treated with epinephrine.
Keywords: red and black fire ants, Solenopsis invicta and richteri, fire ant-venom anaphylaxis prevalence, flying Hymenoptera-venom anaphylaxis prevalence, Systemic mastocytosis (SM)
Received: 02 Feb 2025; Accepted: 18 Mar 2025.
Copyright: © 2025 McMurray, Schornack, Adams, Mccoy, Marshall, Brunader, Maric, Metcalfe and Boggs. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jeremy Clay McMurray, Walter Reed National Military Medical Center, Bethesda, United States
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.