Allergy to Boxelder bugs

A 35-year-old pregnant woman was healthy and had no history of allergies or asthma. During
the fall of that year, her family's new home was infested with boxelder bugs, a common
occurrence in the area. Although these insects were a nuisance, they were not considered
harmful, and the use of pesticides was avoided. The insect infestation subsided with the
arrival of spring but returned the following fall. The patient started experiencing severe
allergic conjunctivitis with itching, redness, and tearing symptoms. Later, she developed
symptoms of allergic rhinitis, including sneezing, nasal itching, rhinorrhea, and nasal
obstruction, which progressed to mild intermittent asthma. The skin prick test was performed
for boxelder bugs, and the patient had a positive wheal and flare reaction.