Bloodsucking flies range in size from the tiny sand fly, about 1 to 3 mm in length, to horse flies that can be over 2 cm. All members stab and pierce the skin, causing some degree of pain and, commonly, subsequent pruritus. Several species, such as deerflies, blackflies, horseflies, and sand flies, can produce allergic reactions, although rarely as severe as those produced by Hymenoptera venom. There is also the possibility of myiasis with fly bites, but this, too, is rare in the United States.
The diagnosis of fly bites depends chiefly on the patient's history and a knowledge of the arthropods that frequent the area of encounter. Treatment for most local reactions to Diptera bites is symptomatic, whereas treatment of systemic reactions is the same as it is for Hymenoptera venom. Cold compresses may alleviate localized edema. Secondary infection from Diptera bites can occur, and antibiotics may be necessary in some cases. Oral antihistamines such as diphenhydramine and hydroxyzine may be helpful in relieving pruritus in these cases, but, topical steroids can be used when local reactions are severe, and oral steroids are indicated when systemic hypersensitivity symptoms are present.
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