Human Health Considerations: Bed Bug Bites


Parola, P. and A. Izri. 2020. Bedbugs. New England Journal of Medicine. 382:2230-2237. DOI: 10.1056/NEJMcp1905840

“This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations.”


Sheele, J. M., G. E. Ridge, K. Coppolino, T. Bonfield, A. B. Young, S. L. Gaines, and T. S. McCormick2017. Antibody and cytokine levels in humans fed on by the common bedbug, Cimex lectularius L. Parasite Immunology. 39: e12411–n/a. doi: 10.1111/pim.12411

“Little is known about cimicosis, the resultant dermal reaction from feeding activity by the common bedbug, Cimex lectularius L. We fed C. lectularius on human study subjects four times over four weeks and measured serum cytokine and antibody levels, and subjects recorded any cimicosis. The average time for subjects to develop cimicosis decreased with each feeding from 8.4, to 2.1, 1.5 and 1.3 days, respectively. There were no significant changes in total IgG, IgG1, IgG2, IgG4 or IgE levels between the first and fourth bedbug feedings, but there was a significant decrease in total IgG3 levels (P<.001). IgG4 was not required for cimicosis. Higher IgG2 and IgG4 levels at study visit 4 were associated with an increased duration of cimicosis (P=.04) and lower pruritis (P=.03), respectively. There were no significant changes in serum TNF-α, IL-1β, IL-4, IL-5, IL-6, IL-10, IFN-γ and IL-17A levels before and one hour after the C. lectularius feeding. Lower post-C. lectularius feeding IL-6 levels were associated with increased pruritis (P =.001) and the time to maximum pruritis (P =.04), respectively. Higher post-C. lectularius feeding IL-5 levels were associated with a longer duration of pruritis (P =.05).”


Goddard, J., A. C. Tardo, and M. E. Embers. 2016. Western blotting of human sera—can it help diagnose bed bug bites? PubMed. 13(5): 345–346.

“Reports of bed bug (Cimex lectularius) infestations and bite reactions have dramatically increased over the past decade and should be included in the differential diagnosis in cases of unexplained insect bites. Proteins in bed bug saliva are readily recognized by the human immune system, leading to various humoral and cellular responses, including production of cytokines/chemokines.”

Minocha, R., C. Wang, K. Dang, C. E. Webb, P. Fernández-Peñas, and S. L. Doggett. 2016. Systemic and erythrodermic reactions following repeated exposure to bites from the common bed bug Cimex lectularius (Hemiptera: Cimicidae). Austral Entomology. 56: 54. doi: 10.1111/aen.12250

“Bed bugs (Cimex spp.) have undergone a global resurgence over the last 15–20 years. They readily bite humans, producing a range of cutaneous reactions. This article documents systemic reactions in two patients following repeated bites from the common bed bug, Cimex lectularius. Both patients had previously fed bed bugs on themselves without any serious complication, however upon feeding a new batch of the insects subsequently developed systemic urticarial reactions. Patient 1 fed 40–50 bed bugs on himself and after 8 min, he developed itch, swelling of the face, lethargy, profuse sweating and widespread wheals on the torso and limbs. The reaction disappeared in 5 h after treatment with systemic prednisone and antihistamines. Patient 2 developed a similar reaction after feeding five to six bed bugs on himself. In this case, the patient also developed chest tightness and breathing difficulties. Following a similar treatment, symptoms disappeared in 4 h. In light of the increasing exposure of this insect to the general public, systemic reactions in patients may present more commonly to the medical practitioner.”

Phan, C., F. Brunet-Possenti, E. Marinho, and A. Petit. 2016. Systemic reactions caused by bed bug bites. Clinical Infectious Diseases. 63: 284–285. doi: 10.1093/cid/ciw253

“Bed bug bites are commonly caused by Cimex lectularius (or C. hemipterus), with a cosmopolitan distribution. Recently, bed bug resurgence has been reported in many occidental countries, presumably due to insecticide resistance and growing international trade and travelling. Bed bug bites usually cause localized reactions such as itchy maculopapular wheals. Systemic reactions have rarely been described, even if severe bullous reactions and anaphylaxis have been reported. We report here an unusual presentation of bed bug bites, associated with systemic symptoms….A 67-year-old man developed erythematous papules on the abdomen, limbs, and bottom for over 1 week, with a general feeling of malaise. The main hypothesis regarding possible causes was bed bug bites, because of the clinical aspect…”

Rahim, A. H. A., Z. Zahran, and A. H. A. Majid2016. Human skin reactions towards bites of tropical bed bug, Cimex hemipterus F. (Hemiptera: Cimicidae): A preliminary case study. Asian Pacific Journal of Tropical Disease. 6: 366–371. doi: 10.1016/S2222-1808(15)61049-0

“To observe the manifestation of skin reactions and determine the time for skin reactions from bites of tropical bed bug (Cimex hemipterus) to disappear on different body parts. Forearm, upper arm and shoulder were exposed to tropical bed bugs and the manifestations of skin reactions afterwards were observed up to 144 h. Itches, wheals and lesions were recorded for the three body parts. Itches were felt for about 15 min for all body parts. The wheals were recorded up to an hour before it flattened, and lesions manifested right after that and lasted for several days. One individual of bed bug took the least time for the skin reaction to disappear while shoulder recorded the longest time for the skin reactions to disappear completely. Different body parts may produce different skin reactions and the time required for the skin reactions to disappear completely was also varied.”

Rahlenbeck, S., J. Utikal, and S. Doggett2016. On the rise worldwide: bed bugs and cimicosis. British Journal of Medical Practitioners. 9: 18–21.

“After they became rare in developed nations over some 30-50 years ago, bed bugs have dramatically increased in incidence and rapidly spread worldwide over the last two decades. Insecticide resistance along with an increase in travel and trade are thought to be the main contributing factors for the resurgence of this public health pest. Bed bugs are not only a hoteliers’ nightmare, but they have also conquered many a private home.”

Shirato, T., H. Iwata, N. Yoshimoto, Y. Nomura, N. Yamane, and H. Shimizu2016. Dermoscopy is useful for bed bug (Cimex lectularius) bites. Journal of the European Academy of Dermatology and Venereology. 30: 539–540. doi: 10.1111/jdv.12938

Letter to Editor. “When seeing a patient suspected of having bed bug bites, dermoscopy is easy and convenient examination to observe haemorrhagic bite spots.”


Foulke, G. T. and B. E. Anderson. 2014. Bed bugs. Seminars in Cutaneous Medicine and Surgery. 33: 119–122. doi: 10.12788/j.sder.0106

“The term bed bug is applied to 2 species of genus Cimex: lectularius describes the common or temperate bed bug and hemipterus its tropical cousin. Cimex lectularius is aptly named; its genus and species derive from the Latin words for bug and bed, respectively. Though the tiny pest is receiving increased public attention and scrutiny, the bed bug is hardly a new problem.”

Langley, R., K. Mack, T. Haileyesus, S. Proescholdbell, and J. L. Annest. 2014. National estimates of noncanine bite and sting injuries treated in US Hospital Emergency Departments, 2001-2010. Wilderness and Environmental Medicine. 25: 14–23. doi: 10.1016/j.wem.2013.08.007

Researchers used data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) to quantify nonfatal bite and sting injuries by noncanine sources. From 2001 to 2010, an estimated 10.1 million people visited emergency departments (ED) for noncanine bite and sting injuries The majority of injuries (67.5%) were from insects, with arachnids (spiders and kin) accounting for the next largest source of injuries (20.8%). The estimated number of ED visits for bed bug bite injuries increased more than 7-fold-from 2,156 visits in 2007 to 15,945 visits in 2010. Costs for medical treatment and lost work time translate to approximately $7.5 billion annually.

Quach, K. A, and A. L. Zaenglein. 2014. The eyelid sign: a clue to bed bug bites. Pediatric Dermatology. 31: 353–355. doi: 10.1111/pde.12332

The insect culprit may be bed bugs when one sees red, swollen bumps on the upper eyelid (the “eyelid sign”). Five of six pediatric patients had small solid bumps on the upper eyelid associated with erythema (redness) and edema (swelling caused by fluid in body tissues).


Bernardeschi, C., L. Le Cleach, P. Delaunay, and O. Chosidow. 2013. Bed bug infestation. British Medical Journal. 346:f138. doi: 10.1136/bmj.f138

A literature review of the current methods for identifying and controlling bed bug infestations as well as the clinical signs of bed bug bites.


Cimolai, N., and T. L. Cimolai2012. Otitis from the common bedbug. The Journal of Clinical and Aesthetic Dermatology. 5: 43–45.

“There is a resurgence of interest in the biology and clinical disease associated with Cimex lectularius, as the common bed bug is becoming more prevalent in well-developed countries. A patient presented with complaints of right ear irritation for several days’ duration. A foreign body was lavaged from the ear canal, which proved to be an engorged nymphal form of Cimex lectularius. The parasite had apparently obtained a blood feed from the tympanic membrane. The resolution of the illness was unremarkable. This ectoparasite is currently re-emerging as a human pest worldwide. The case report herein describes a new variation of the dermatological manifestations from this infestation.”

de Shazo, R. D., M. F. Feldlaufer, M. C. Mihm, and J. Goddard. 2012. Bullous reactions to bedbug bites reflect cutaneous vasculitis. The American Journal of Medicine. 125: 688–694. doi: 10.1016/j.amjmed.2011.11.020

Bed bugs bites can cause complex (bullous) cutaneous reactions in some people. In this study, the time course of bullous reactions was documented and tissues were microscopically examined in order to determine the best medical treatment for such bites. Bullous reactions are medically significant as they are associated with local, highly destructive, cutaneous vasculitis (inflammation of the blood vessels). An examination of Internet postings of bed bug bite photographs (357) revealed that 6% were bullous reactions, indicating that this is not a rare reaction to bed bug bites.

Doggett, S. L., D. E. Dwyer, P. F. Peñas, and R. C. Russell. 2012. Bed bugs: clinical relevance and control options. Clinical Microbiology Reviews. 25: 164–192. doi: 10.1128/CMR.05015-11

A literature review focusing on the clinical signs of bed bug bites and control methods.

Price, J. B., A. Divjan, W. R. Montfort, K. H. Stansfield, G. A. Freyer, and M. S. Perzanowski2012. IgE against bed bug (Cimex lectularius) allergens is common among adults bitten by bed bugs. Journal of Allergy and Clinical Immunology. 129: 863–865.e2. doi: 10.1016/j.jaci.2012.01.034

“We developed assays for measuring IgE against allergens from bed bugs (Cimex lectularius). Among adults reporting bed bug bites, sensitization to these allergens was common, suggesting the potential for allergic responses to bed bug exposure.”

Sciscione, P. 2012. Bed bugs: They are back! The role of the school nurse in bed bug management. NASN (National Association of School Nurses) School Nurse. 27: 268–273. doi: 10.1177/1942602X12456209

Literature review focusing on the historical presence of bed bugs, current pest management techniques, identification of bed bug bites, and how school nurses can use this information to educate parents and prevent bed bug transmission in schools.


Goddard, J., K. T. Edwards, and R. D. de Shazo. 2011.  Observations on development of cutaneous lesions from bites by the common bed bug, Cimex lectularius. L. Midsouth Entomologist. 4: 49–52.

Researchers documented the progression of skin reactions following bed bug bites on a previously unexposed individual.

Nazarko, L. 2011. Bed bug bites: identification, treatment and prevention. British Journal Healthcare Assistants. 5: 12–14. doi: 10.12968/bjha.2011.5.1.12

“The number of bedbug infestations has tripled in the last 10 years. Considering that bed bug bites are often misdiagnosed, it is important for healthcare assistants (HCAs) and assistant practitioners (APs) to be able to identify bed bug bites. Therefore, this article aims to enable HCAs and APs to understand why bed bug bites occur, how they are treated and how bed bugs can be eradicated from the patient’s environment.”


Doggett, S. L., and R. Russell. 2009. Bed bugs: what the GP needs to know. Australian Family Physician. 38: 880–884.

A review article focusing on the medical effects of bed bug bites, proper medical treatment procedures, and control methods.

Goddard, J., and R. de Shazo. 2009. Bed bugs (Cimex lectularius) and clinical consequences of their bites. Journal of the American Medical Association. 301: 1358–1366. doi: 10.1001/jama.2009.405

Review of journal articles and other literature focusing on clinical data regarding bed bug bites and human responses. The authors concluded that clinical trials have not be performed to evaluate treatment options for cutaneous and systemic reactions from bed bug bites, and no evidence exists that outcomes significantly differ from those receiving no treatment.

Kolb, A., G. R. Needham, K. M. Neyman, and W. A. High. 2009. Bedbugs. Dermatologic Therapy. 22(4): 347-352. doi: 10.1111/j.1529-8019.2009.01246.x

Cimex lectularius (the “bedbug”) is an insect that feeds nocturnally, taking a requisite blood meal from a sleeping human or other parasitized host. Immunological reactions to bedbug saliva vary, but typically, bites yield erythematous and pruritic papules. The face and distal extremities, areas uncovered by sleeping clothes or blankets, are preferentially involved. Until the late 1990s, bedbug infestations in the United States were declining. Resurgence is attributed to increased travel and resistance to insecticides. Although hepatitis or human immunodeficiency virus is not effectively transmitted by the bedbug, pruritus and the fear and perceived violation of an infestation can be debilitating. Bedbugs are small but robust, and their ability to remain ensconced in crevices within the bedroom makes eradication difficult. As more patients present with bedbug bites, physicians must possess the knowledge to diagnose, treat, and educate with regard to bedbug bites and bedbug infestations.”

Reinhardt, K., D. Kempke, R. A. Naylor, and M. T. Siva-Jothy. 2009. Sensitivity to bites by the bedbug, Cimex lectularius. Medical and Veterinary Entomology. 23: 163–166. doi: 10.1111/j.1365-2915.2008.00793.x

Case reports and published papers on bed bug bites were reviewed to assess the commonly cited estimate that about 80% of the population is sensitive to bed bug bites. The authors found that this sensitivity estimate was based on a single study carried out 80 years ago that did not account for the fact that only repeated exposure to external allergens leads to skin reactions. In the current study, 18 of 19 humans showed a skin reaction, but typically only have repeated exposure to bed bug bites. Multiple bed bug exposures increased the likelihood of a skin reaction and decreased the length of time between the bite and the skin reaction.