Skeeter Syndrome: A Severe Mosquito Bite Hypersensitivity Reaction
Skeeter syndrome is defined as a large local inflammatory reaction to mosquito bites, sometimes accompanied by systemic symptoms such as fever and vomiting. 1 It represents an immunological hypersensitivity reaction to proteins in mosquito saliva.
Clinical Presentation
Local Manifestations
- Exaggerated local inflammatory response at the bite site
- Significant swelling and erythema extending beyond the bite site
- Ecchymosis (bruising) at the bite location
- Cutaneous thickening that can persist for weeks
- Localized paresthesia (abnormal sensation) 2
Systemic Manifestations
Pathophysiology
Skeeter syndrome involves multiple immunological mechanisms:
- IgE-mediated hypersensitivity (type I)
- IgG-mediated reactions
- T-cell mediated hypersensitivity 1
This is distinct from normal mosquito bite reactions, which typically present as small, self-limiting pruritic papules.
Diagnosis
Diagnosis is primarily clinical, based on:
- History of mosquito exposure
- Characteristic large local reaction disproportionate to a typical bite
- Possible systemic symptoms
- Positive skin tests to mosquito allergens 1
Differential Diagnosis
- Cellulitis (bacterial skin infection)
- Angioedema
- Contact dermatitis
- Other arthropod bite reactions
- Early necrotizing fasciitis
Management
Acute Treatment
- Antihistamines to reduce itching and inflammation
- Oral corticosteroids for severe reactions (prednisone may be required) 3
- Cold compresses to reduce swelling
- Analgesics for pain management
Prevention
- Application of insect repellents containing:
- DEET (10-35%)
- Picaridin (20%) 3
- Wearing protective clothing
- Using mosquito nets and screens
- Avoiding outdoor activities during peak mosquito hours
- Eliminating standing water around homes
Special Considerations
Children
Children may experience more severe reactions due to:
- Less prior exposure to mosquito antigens
- Thinner skin allowing deeper penetration of mosquito saliva
- Potentially stronger immune responses
Recurrence
- Reactions typically recur with subsequent mosquito bites
- Severity may increase with repeated exposures
- Some patients develop desensitization over time
Warning Signs
Seek immediate medical attention if:
- Severe swelling affecting breathing or swallowing
- Signs of secondary infection (increasing pain, warmth, purulent drainage)
- High fever or severe systemic symptoms
Distinction from Other Conditions
It's important to distinguish Skeeter syndrome from more serious conditions such as:
Severe Mosquito Bite Allergy (SMBA) - A rare condition associated with Epstein-Barr virus infection that can lead to ulceration, necrosis, and potential progression to NK/T-cell lymphoma 4
Hypersensitivity to Mosquito Bites Epstein-Barr Virus NK (HMB-EBV-NK) disease - A more severe systemic condition with risk of malignant transformation 5
Skeeter syndrome, while uncomfortable and sometimes alarming in appearance, does not carry these serious long-term risks and generally resolves with appropriate symptomatic treatment.