Two people spend an evening in the same garden and receive roughly the same number of mosquito bites. By morning, one barely notices them - while the other is covered in large, swollen, intensely itchy welts that linger for days.
Author
- Khalid Beshir
Lecturer in Biomedical Science, University of East London
Most of us have experienced this, or know someone who has. But why is it that mosquito bites affect some people so differently? The answer lies in the way a mosquito's saliva interacts with our unique immune system .
When a mosquito bites you, they inject saliva into your skin. The immune system recognises the saliva as foreign and releases histamine - an immune cell chemical that causes allergy symptoms such as redness, swelling and itchiness.
But this only partly explains what's going on. A mosquito's saliva also contains a range of other biologically active compounds that interact with the immune system in more complex ways than once assumed.
For instance, a mosquito's saliva also contains proteins that prevent blood clotting and keep blood flowing so they can feed undisturbed.
These same salivary proteins influence the immune response that occurs at the bite site . Rather than acting solely as a feeding aid, mosquito saliva can alter the local immune environment within minutes of a bite.
In plain terms, the saliva nudges the immune system toward a particular kind of response (called a "Th2" response ) that's more associated with allergy-type reactions than with fighting infection. This makes nearby blood vessels temporarily "leakier" which helps draw extra immune cells to the area.
For a simple bite, this mostly just means more redness, swelling and itching. But researchers think this same immune shift may also make it easier for viruses carried by the mosquito to get established in the skin and spread through the body.
Why some people react more strongly
One of the most striking features of mosquito bites is the enormous variation in how people respond.
A large genetic study of over 84,000 people backs this up. People reported experiencing everything from small, mild bumps to large, swollen ones. Even the same person's reactions to mosquito bites changed over time.
Children often react more strongly than adults , and people exposed to unfamiliar mosquito species may also respond differently because saliva varies between species. The reason for this is largely due to exposure.
Reactions tend to be strongest the first few times someone is exposed to a particular mosquito species. They tend to settle down with repeated exposure as the immune system adjusts - a bit like gradually building tolerance.
Because children simply haven't been bitten as many times yet, they're more likely to still be in that stronger-reaction phase. The same logic explains the "unfamiliar species" effect: an adult who reacts mildly to their local mosquitoes can react strongly on a trip somewhere with different mosquito species, since their immune system hasn't encountered those particular saliva proteins before.
Genetics probably contribute too, with inherited differences in immune regulation influencing how strongly a person responds.
But the key reason that people react so badly to mosquito bites comes down to having a mild hypersensitivity to mosquito saliva.
A much smaller number of people develop exaggerated local reactions, sometimes called Skeeter syndrome , where swelling extends well beyond the bite itself and is often mistaken for bacterial cellulitis (a skin infection that causes redness and swelling).
There is no single known cause of hypersensitivity. However, Skeeter syndrome is thought to result from an unusually strong immune response to the proteins in mosquito saliva, involving mosquito-specific antibodies and other inflammatory immune responses.
Why some people develop this exaggerated response is not fully understood - although age, previous exposure to mosquitoes and individual susceptibility may all play a role. Fortunately, severe allergic reactions to mosquito bites are extremely uncommon .
If you're someone that reacts badly to mosquito bites, applying a cold compress soon after a bite may help reduce swelling. Oral antihistamines and mild topical corticosteroid creams can also relieve itching and inflammation, particularly when used early.
Avoid scratching as this can prolong inflammation, damage the skin and increase the risk of infection. People who develop unusually large reactions, worsening pain or fever should seek medical advice.
Preventing bites remains the best strategy. Using insect repellents, covering exposed skin and sleeping under insecticide-treated bed nets where mosquito-borne diseases occur can all reduce the risk of being bitten.
Mosquito saliva and disease
The implications of mosquito saliva extends beyond the annoying, itchy bites they leave behind.
Researchers are increasingly recognising that these salivary proteins may influence what happens when pathogens are transmitted from mosquitoes to humans.
Specifically, the same immune changes that cause the itchy bites in the first place appear to help mosquito-born viruses such as dengue, Zika and West Nile virus establish a stronger initial infection and spread through the body faster than if the virus were injected without saliva alongside it.
Another intriguing discovery comes from malaria research. A landmark study found that children infected with Plasmodium falciparum, which is the parasite species responsible for the most severe form of human malaria, produced altered body odours compared with uninfected children. Several chemical compounds were present at higher levels, and mosquitoes were attracted to some of these odours.
These findings suggest malaria parasites may alter host odours in ways that could increase mosquito attraction, potentially improving their chances of transmission.
It's for these reasons that scientists are currently exploring vaccines that target mosquito saliva itself, not just the pathogens it carries.
A mosquito bite may seem like a minor summer irritation, but it reflects a complex interaction between mosquito saliva and the immune system.
Khalid Beshir does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
