Mosquito bite hypersensitivity in children: Clinical features outweigh specific IgE in diagnosis.

Background

Mosquito bite hypersensitivity results from abnormal immune responses to salivary proteins with potent immunomodulatory properties. In children, both type I (immunoglobulin E [IgE] mediated) and type IV (cell mediated) mechanisms contribute to the reaction spectrum, ranging from localized erythema to extensive inflammatory lesions. Although mosquito-specific IgE assays are commercially available, their diagnostic utility and correlation with clinical severity remain unclear.

Objective

The objective was to describe the clinical and immunologic characteristics of children with mosquito hypersensitivity, evaluate the diagnostic relevance of mosquito-specific IgE, and explore associations with atopic background.

Methods

A retrospective study was conducted on 206 children who underwent mosquito-specific IgE testing between June 2023 and June 2025. The mosquito allergy group included children with large local reactions, prolonged lesions, or systemic symptoms; the controls had typical reactions only. Clinical features, atopic comorbidities, total IgE levels, eosinophil percentages, and inhalant sensitizations were compared between the groups.

Results

Atopic diseases were significantly more common in the mosquito allergy group versus the controls (87.0% versus 52.7%; p < 0.001). Mosquito-specific IgE positivity was low and similar across the groups (mosquito allergy group 6/77 [7.8%] vs controls 13/129 [10.1%]; p = 0.63), which showed no correlation with reaction type, duration, or severity. The total IgE levels were significantly higher in the mosquito allergy group (p = 0.045). The most frequent lesions were erythematous papules (88.3%) and immediate wheals (89.6%), whereas bullous lesions were rare (7.8%) and self-limited. Quality of life was mainly affected by avoidance of outdoor activities (16.9%) and psychological distress (15.6%).

Conclusion

In pediatric mosquito hypersensitivity, clinical assessment outweighs mosquito-specific IgE testing for diagnosis. Despite the strong association with atopy, specific IgE positivity remains low, which supports the primacy of clinical history and lesion morphology in diagnostic decision-making.