Anaphylactic reaction after Hippobosca equina bite

A 48-year-old female received the bite of an unidentified insect in summer time.Almost immediately she experienced generalized pruritus. Then she developedurticaria, abdominal pain, nausea, angioedema on the face, and dyspnoea. After-wards, in the out-patient department, she underwent an allergic screening throughskin prick tests to Hymenoptera venom and dosage of specific IgE (Cap System).They revealed sensitization to Apis m, Vespula spand Polistes sp. In fact the pa-tient reported urticaria and angioedema after previous Hymenoptera stings. Weperformed a skin prick test with Tabanus extracts and obtained a positive reaction(wheal 5 mm). Later on, the patient captured the culprit insect and, after havingconsulted an entomologist, we were able to identify it as a fly from Hippobosci-dae family: Hippobosca equina(H. e.). However, we cannot fully rely on skinprick tests and specific IgE, since for the time being the extract for H. e. allergyis not available. Our case is the first clinical report of an allergic reaction after thebite of Hippobosca. ein a patient with sensitization to Hymenoptera venom.Palabras clave: Anaphylaxis. Cross-reaction. Hymenoptera. Diptera. Hippo-bosca equina.Anaphylaxis to the sting of insect in Italy is very frequent, especially toHymenoptera family