The Kiss of Death: A Rare Case of Anaphylaxis to the Bite of the "Red Margined Kissing Bug".

Triatoma (kissing bugs), a predatory genus of blood-sucking insects which belongs to the family Reduviidae, subfamily Triatominae, is a well-known vector in the transmission of Trypanosoma cruzi, the causative agent in Chagas disease. However, it is less well appreciated that bites from these insects can cause a range of symptoms varying from localized cutaneous symptoms to a generalized anaphylactic reaction. While anaphylactic reactions following bites have been reported with five of the eleven species endemic to the United States, the majority are associated with Triatoma protracta, and Triatoma rubida. There have been very few reported cases of anaphylactic reaction to the bite Triatoma rubrofasciata, which is endemic to Florida and Hawai'i. We report a case of a 50 year old previously healthy female from a rural area in Honolulu County who suffered three separate bites from Triatoma rubrofasciata and experienced a generalized anaphylactic reaction on each occasion. There is currently no commercially available skin test to determine allergy to Triatoma bites, and there is likewise no immunotherapy. Avoidance is the best strategy and allergic patients should always have an epinephrine auto injector readily available.