Predictors of severe anaphylaxis in Hymenoptera venom allergy: The importance of absence of urticaria and angioedema.
Adolescent
Adult
Aged
Aged, 80 and over
Anaphylaxis
/ immunology
Angioedema
/ immunology
Animals
Bee Venoms
/ adverse effects
Cohort Studies
Female
Humans
Hypersensitivity
/ immunology
Insect Bites and Stings
/ complications
Male
Middle Aged
Retrospective Studies
Risk Factors
Tryptases
/ blood
Urticaria
/ immunology
Young Adult
Journal
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
ISSN: 1534-4436
Titre abrégé: Ann Allergy Asthma Immunol
Pays: United States
ID NLM: 9503580
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
28
01
2020
revised:
08
03
2020
accepted:
09
03
2020
pubmed:
23
3
2020
medline:
26
9
2020
entrez:
23
3
2020
Statut:
ppublish
Résumé
Severe anaphylaxis (SA) in Hymenoptera venom allergy has been associated with a number of risk factors. However, the effect of several of those risk factors on the severity of anaphylaxis is poorly defined. To evaluate risk factors for SA in Hymenoptera venom allergy. We evaluated data from 500 patients who were referred to our department for the diagnosis of Hymenoptera venom allergy during a period of 11 years to identify risk factors for SA. Six significant risk factors for SA were identified (P < .05): short interval from sting to reaction, absence of urticaria or angioedema (U/A) during anaphylaxis, older age, male sex, elevation of baseline serum tryptase (BST) level, and diagnosis of systemic mastocytosis. Moreover, elevation in BST level was significantly associated with the absence of U/A and older age. No association could be established between SA and comorbidities, concurrent cardiovascular medication, or the severity of the systemic reaction during the initiation of venom immunotherapy. Apart from BST and older age, male sex, short interval from sting to reaction, and absence of U/A are also risk factors for SA. The association between elevated BST level and SA was largely confined to those who had an absence of U/A after field sting, possibly because of the higher risk of concurrent systemic mastocytosis. Patients with an SA after a field sting do not have an elevated risk of systemic reactions during the initiation of venom immunotherapy compared with patients with mild anaphylaxis; therefore, additional preventive measures are not necessary.
Sections du résumé
BACKGROUND
Severe anaphylaxis (SA) in Hymenoptera venom allergy has been associated with a number of risk factors. However, the effect of several of those risk factors on the severity of anaphylaxis is poorly defined.
OBJECTIVE
To evaluate risk factors for SA in Hymenoptera venom allergy.
METHODS
We evaluated data from 500 patients who were referred to our department for the diagnosis of Hymenoptera venom allergy during a period of 11 years to identify risk factors for SA.
RESULTS
Six significant risk factors for SA were identified (P < .05): short interval from sting to reaction, absence of urticaria or angioedema (U/A) during anaphylaxis, older age, male sex, elevation of baseline serum tryptase (BST) level, and diagnosis of systemic mastocytosis. Moreover, elevation in BST level was significantly associated with the absence of U/A and older age. No association could be established between SA and comorbidities, concurrent cardiovascular medication, or the severity of the systemic reaction during the initiation of venom immunotherapy.
CONCLUSION
Apart from BST and older age, male sex, short interval from sting to reaction, and absence of U/A are also risk factors for SA. The association between elevated BST level and SA was largely confined to those who had an absence of U/A after field sting, possibly because of the higher risk of concurrent systemic mastocytosis. Patients with an SA after a field sting do not have an elevated risk of systemic reactions during the initiation of venom immunotherapy compared with patients with mild anaphylaxis; therefore, additional preventive measures are not necessary.
Identifiants
pubmed: 32199978
pii: S1081-1206(20)30151-4
doi: 10.1016/j.anai.2020.03.007
pii:
doi:
Substances chimiques
Bee Venoms
0
Tryptases
EC 3.4.21.59
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
72-77Informations de copyright
Copyright © 2020 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.