Risk factors and indicators of severe systemic insect sting reactions.
Johanna StoevesandtGunter Johannes SturmPatrizia BonadonnaJoanna N G Oude ElberinkAxel TrautmannPublished in: Allergy (2019)
Hymenoptera venom allergy ranks among the top three causes of anaphylaxis worldwide, and approximately one-quarter of sting-induced reactions are classified as severe. Fatal sting reactions are exceedingly rare, but certain factors may entail a considerably higher risk. Delayed administration of epinephrine and upright posture are situational risk factors which may determine an unfavorable outcome of the acute anaphylactic episode and should be addressed during individual patient education. Systemic mastocytosis and senior age are major, unmodifiable long-term risk factors and thus reinforce the indication for venom immunotherapy. Vespid venom allergy and male sex likewise augment the risk of severe or even fatal reactions. Further studies are required to assess the impact of specific cardiovascular comorbidities. Available data regarding potential effects of beta-blockers and/or ACE inhibitors in coexisting venom allergy are inconclusive and do not justify recommendations to discontinue guideline-directed antihypertensive treatment. The absence of urticaria/angioedema during sting-induced anaphylaxis is indicative of a severe reaction, serum tryptase elevation, and mast cell clonality. Determination of basal serum tryptase levels is an established diagnostic tool for risk assessment in Hymenoptera venom-allergic patients. Measurement of platelet-activating factor acetylhydrolase activity represents a complementary approach but is not available for routine diagnostic use.
Keyphrases
- risk factors
- drug induced
- early onset
- risk assessment
- angiotensin converting enzyme
- high glucose
- healthcare
- atopic dermatitis
- diabetic rats
- end stage renal disease
- newly diagnosed
- angiotensin ii
- oxidative stress
- liver failure
- human health
- quality improvement
- electronic health record
- heavy metals
- intensive care unit
- high resolution
- climate change
- solid phase extraction
- artificial intelligence
- aedes aegypti
- molecularly imprinted
- extracorporeal membrane oxygenation
- allergic rhinitis