Human immune responses to ticks and other arthropods limit the impact of vector-borne disease but also can cause mild to life-threatening hypersensitivity reactions. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Ticks rely on blood meals to complete their life cycle. Tick salivary proteins make this possible by inhibiting blood coagulation, local itch and host anti-tick immune responses. Tick saliva also serves as a conduit for tick-borne pathogens. Both salivary proteins and the pathogens they help transmit are targeted by host immune mechanisms. These intensify with repeated tick exposure. Salivary protein function is impaired and eventually blocked by host immunity, resulting in the interruption of tick feeding and prevention of pathogen transmission. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Mammalian hosts differ in their immune response to ixodid tick bites. For example, Clethrionomys glareolus (bank vole)and Apodemus flavicollis (yellow-necked mouse) are natural rodent hosts for Ixodes ricinus in Europe but voles experience a strong hypersensitivity response to repeated infestations of I ricinus while mice do not. 12 Humans also vary in their response to tick bite, depending primarily on how frequently they are bitten. In this review, we focus on human hypersensitivity to ixodid (hard bodied) ticks, such as Dermacentor spp., Haemaphysalis spp., Ixodes spp. and Rhipicephalus spp. Ixodid ticks transmit infection throughout the world and are responsible for the majority of vector-borne diseases in the United States, including human granulocytic anaplasmosis, babesiosis, Borrelia miyamotoi infection, Colorado tick fever, ehrlichiosis, Heartland virus infection, Lyme disease, Powassan virus disease, rickettsiosis, Rocky Mountain spotted fever, Southern tick-associated rash illness (STARI), tick-borne encephalitis and tularaemia. 2,