Finally, the weather has warmed up and summer has arrived (at least in my country, Lithuania). Once again, we begin to grumble about the weather: some complain that it's too cold, others that it's too hot, there's either too little rain or too much, and we impatiently wait for the holidays. We also have to remember the small unpleasant things – insects that can ruin trips to nature or night's sleep. There is a great saying: "If you think you're too small to make an impact, try sleeping in a room with a mosquito."

This time, let's talk about mosquitoes and their bites. The topic is very relevant, because when a child gets bitten by several mosquitoes and the bite locations swell a little, parents immediately start mentioning allergies. It's no secret that doctors, wanting to ease the situation, also say that the child is allergic to mosquito bites – and the parents calm down, and there's no need for long explanations. The only problem is that the prescribed antiallergic drugs, particularly antihistamines, don't really help. It would be ideal if, after taking drops or syrups, all the bites would suddenly disappear. Unfortunately, that doesn't happen because when a mosquito bites, it pierces the skin with its long mouthpart, sucks blood, and secretes saliva into the human blood. Thus, fluid exchange occurs between the mosquito and human bloodstream. A recent proteome study identified 1,208 proteins from the salivary glands of female Aedes aegypti mosquitoes. So when a mosquito bites, we receive quite a bouquet of various compounds that can cause inflammation in the skin.

Mosquitoes bite and suck blood for reproduction. While male mosquitoes feed only on flower nectar, female mosquitoes drink both flower nectar and blood. Females need proteins in the blood to develop eggs. Thus, only females bite. There are three different types of mosquitoes living in various parts of the world: Aedes, Culex, and Anopheles.

Mosquitoes are not just harmless creatures that suck blood to survive. Unfortunately, they spread diseases that are often deadly. Therefore, mosquitoes are considered disease vectors (creatures that transmit diseases between animals and humans). With climate change, it is likely that we all have to become familiar with, learn to diagnose, and treat diseases such as chikungunya, Zika, dengue fever, yellow fever, malaria, and West Nile virus infections. So, if you travel to various countries in Africa, the Americas, South and South East Asia, and the Western Pacific region or live there, you should not forget the risk of contracting these infections from mosquito bites.

There are various theories, myths, or speculations about why mosquitoes bite some people more than others. This is influenced by the perfumes used, blood type, clothing, body temperature, and the location where you are. Mosquitoes are usually near water because they lay eggs in shallow, stagnant water, mostly in swamps, ponds, lakes, children's pools, inside tires, bird baths, and other watery places.

So what happens when a mosquito bites? Typically, mosquito bites appear as small, raised bumps on the skin. Often mosquito bites do not cause long-term damage, only leading to slight skin irritation and, of course, itching for a short time. Mosquito saliva contains histamine, and when it bites, our immune system cells release even more histamine to start inflammation. The more histamine, the more intense the itching. If a child's body already has a lot of histamine, hives can occur.

What causes a lot of histamine to accumulate in the body? Any inflammation or infection, if the child is ill, and an excessive amount of certain foods – sweets, ice cream, various fruits, and berries – can lead the body to react more intensely to bites: the itching will be more severe, the redness and swelling more pronounced. Hence, antihistamines are often prescribed. They won't eliminate the inflammation but will slightly reduce itching and redness.

The main rule is that itching will intensify once you start to scratch. Scratching increases the area of inflammation, it will spread, and healing will take longer. Besides, if we scratch with dirty fingers, there's a risk of infection entering the wound. Then, antibacterial ointment or antibiotics might be needed if the bacterial infection spreads. Therefore, if you see that a child is scratching intensely, wash and disinfect that area of the skin. This will help prevent complications.

When a mosquito bites, inflammation begins at the skin damage site, which typically lasts about 5 days. First, there is swelling and redness. As with any injury, it is best to cool the area. Cooling gels and cooler water are suitable, as cold reduces itchiness. Local remedies for mosquito bites can slightly reduce skin itching and discomfort. There are various types – creams, ointments, oils. However, if you have purchased a new, previously unused remedy, first test it on a healthy area of the skin and see if it causes any unwanted reactions, additional skin irritation, rash, or itching. This is especially important for children, as their skin is much more sensitive than that of adults.

Children's subcutaneous layer is very soft and supple, so if a mosquito bites where the skin is thin, the swelling can be extensive. Especially if it bites near the eye or on the face, swelling can be very severe. Many mothers are scared when they see their child in the morning with a swollen face or swelling around the eye or, as if after an injury, with a large bump on the forehead. There's no need to worry too much – the swelling usually subsides quite quickly. I understand that a lot is said on social media about anaphylactic reactions, that children's throats could swell and choking is a risk. So anything that swells even slightly on the face can be frightening. But I would advise – after reading such "horror stories," pay attention to the child themselves, how he feels, whether it seems that his condition is such that they need resuscitation? "The swelling looks ugly" is not a symptom of an anaphylactic reaction.

Systemic allergic, i.e., anaphylactic, life-threatening reactions to mosquito bites, are very rare. Scientific literature describes systemic allergy only to one type of mosquito – Aedes aegypti, found in tropical, subtropical and temperate regions throughout the world. Speaking about allergy to these mosquitoes, two types of allergies are mentioned: allergy to allergens in mosquito saliva, which occurs after a mosquito bite, and allergy to somatic allergens, which manifests as allergic rhinitis and bronchial asthma after inhaling mosquito allergens or contact with them. And if this type of mosquito will be more detected in much more countries and the number of children allergic to these mosquitoes will increase, then, with the help of immunotherapy, we will be able to treat this allergy, just as allergies to other hymenoptera (bees, bumblebees) insect allergens are treated.

So if not the "dreaded" allergy, why do some people develop a large, painful, red, and hot-to-the-touch swelling, sometimes even with blisters after a mosquito bite? Why do some even get a fever or swollen lymph nodes? This is called Skeeter syndrome – a localized inflammatory reaction to a mosquito bite, more precisely to the proteins in mosquito saliva. Symptoms of Skeeter syndrome can start roughly 8-10 hours after the mosquito bite. There is not much information about why this happens, but it has been determined that such an immune response, mediated by IgE and IgG antibodies, often forms in those who have not yet developed immune tolerance to the proteins in mosquito saliva. Therefore, this syndrome occurs much more often in children and people whose immune systems are very weakened or in an immunodeficient state.

How to help a child if, it seems, half of the arm or leg is terribly swollen and painful? Antihistamines definitely won't perform a miracle. Local or systemic anti-inflammatory drugs (such as ibuprofen, which also reduces pain), corticosteroid ointments, and if the swelling is extensive, oral, systemic hormones are prescribed. Local cooling compresses and gels can also reduce the feeling of tightness and pain for a while. Symptoms usually disappear within 3–10 days.

So what to do to prevent mosquito bites? We can't forbid relaxing near lakes or rivers because of it. There are indeed plenty of mosquito repellents – from candles, lamps to solutions. And if you purchase products suitable for use on skin or clothing, I remind you that it is not enough to spray them once – it’s important to read the instructions. For children, products tailored for them should be chosen, as they are milder and less irritating. The less aggressive the product, the more often it needs to be applied. Of course, proper clothing, special nets on windows, playpens, or strollers should be used.

I know how irritating the buzzing of mosquitoes is, and it's even more annoying to have itching caused by a mosquito bite. But if we react to this calmly, mosquitoes certainly won't spoil the joys of summer.