Risk of anaphylaxis in patients with large local reactions to hymenoptera stings: a retrospective and prospective study (original) (raw)

A reminder of life-threatening reaction of hymenoptera sting cause anaphylaxis shock

International Journal of Advances in Medicine

The prevalence of hymenoptera sting in general population still high. Large local reaction (LLR) is more common manifestation but can also cause anaphylactic shock and loss of consciousness, or even cardiac or respiratory arrest that all is defined as severe systemic sting reaction (SSR). The risk is generally considered low for future SSR in subjects with LLR but need to be considered and recognized immediately. We reported a case of 39-year-old women was stung by a wasp when driving motorcycle and presented to emergency room with anaphylactic shock (fulfill the amended NIAID/FAAN criteria). She also stung by wasp 2 years ago and cause her left upper and lower arms became swollen slowly and improved 3 days later after treatment with allergy drugs. Electrocardiography result refer to sinus bradycardia. Significant laboratory result showed hypokalemia (2.9 mmol/l). Patient treated by injecting epinephrine intramuscularly and glucocorticoids to preventing protracted symptoms and bipha...

Unusual Reactions to Hymenoptera Stings: What Should we Keep in Mind?

Clinical Reviews in Allergy & Immunology, 2014

This review includes a variety of extremely rare and unusual hymenoptera sting (HS) circumstances with regard to sting localization, geographic region, massivity of multiple stings, and particularly related to clinical symptoms. Such reactions occur in a temporal relationship to HS (s), differ from typical allergic symptomatology, and sometimes need follow-up during many months. With respect to pathogenesis, the major mechanisms involved are toxic, autoimmune, and other delayed immunological ones. While delayed inflammatory symptoms of the nervous system are considered as delayed hypersensitization or autoimmune entities, generalized rhabdomyolysis and consecutive acute kidney injury is considered a toxic reaction, mostly induced by massive envenomation to wasps or "Africanized" bees. Hemorrhagic episodes of targeted organ (s) could be additional potential risk for acute kidney injury, while the bee venom-induced hemorrhage is proposed to be a nonimmune-mediated anaphylactic symptom. The hemodynamic involvement of vital organs and systems with hypoxia and hypovolemia together with simultaneous immunoglobulin E (IgE) sensitization are considered potential indications for venom immunotherapy. In contrast, patients who have experienced various complications with unknown or nonallergic mechanisms should be informed about the importance of epinephrine's use and additional measures on future sting avoidance. In conclusion, although unusual reactions are extremely rare, it is important to keep them in mind.

Long-term follow-up of re-sting reactions in children with moderate to severe venom hypersensitivity

European journal of pediatrics, 2015

Few data exists about re-sting reactions and their prognosis in children with moderate to severe venom hypersensitivity. The reasons behind not consenting to or prematurely ending venom immunotherapy (VIT) and the preparedness of children who refused or quit VIT for future moderate-severe systemic reaction (SR) to re-stings have not been studied. Data on children with moderate to severe SR after Hymenoptera stings was collected for a 17-year period using our database. A standardized questionnaire was administered to patients who accepted to be interviewed at the clinic. These patients were evaluated in terms of their preparedness for future moderate-severe SR to re-stings. A total of 55 children, 75 % of whom commenced on VIT, were included in the analysis. Different reasons exist for not consenting to VIT; the most common of which is living at a distance from the allergy center. There were no differences in terms of the number of re-stung patients (27.7 and 27.2 %, respectively) an...

Negative venom skin test results in patients with histories of systemic reaction to a sting

Journal of Allergy and Clinical Immunology, 2003

For more than 20 years venom immunotherapy has been the preferred treatment for Hymenoptera allergy and venom skin testing the preferred diagnostic test. Most allergists consider venom skin tests to be highly accurate and interpret a negative venom skin test result to indicate the absence of insect allergy. Furthermore, current practice guidelines do not adequately address the question of how best to manage the patient with a convincing history of insect allergy but negative skin test results. Recent case reports and published studies have forced us to reexamine this important management issue and to consider what role in vitro venom testing might have in the management of insect allergy. We reviewed the current status of what is known about the management of individuals with a history of insect allergy but negative venom skin test results and suggested modifications of current working guidelines.

Prevalence of allergy to hymenoptera stings in different samples of the general population

Journal of Allergy and Clinical Immunology, 1992

Decreased gamma interferon Jn AD NUMBER 3, PART 1 acterization of monoclonal antibodies specific for the human IFN-3, receptor. J [mmunol 1988;140:4231-6. 28. Boguniewicz M, Jaffe H, Izu A, et al. In vivo treatment of patients with atopic dermatitis and elevated lgE levels with recombinant gamma interferon. Am J Med 1990;88:376-9. 29. Parkin JM+ Eales L-J, Galazka AR, Pinching AJ. Atopic man-ifestations in the acquired immune deficiency syndrome: re+ sponse to recombinant interferon gamma. BMJ ~987:2t)4: 1185-6. 30. Schneider LC, Hanifin J, Cooper K, et al. Recombinant interferon gamma therapy reduces the clinical severity of atopic dermatits. J ALLERGY To get figures of prevalence of systemic reactions (SRs) to hymenoptera sting in adults between the ages of 18 to 65 years, we performed three different surveys using the same questionnaire from 1984 to 1988. The first one was a door-to-door survey in Southeast France, which included 8271 adults and used a questionnaire. The second one, which included 2067 adults, was performed in a health care center and comprised the same questionnaire and venom skin tests in subjects reporting a history of SRs. The third survey was a national poll performed through a home-based national computer network. The percentage of SRs ranged from 0.66% in the second survey including skin tests to 3.3% in the poll survey. The higher prevalence figure in this latter survey may be related to a false-positive history, There was no urban-rural difference in prevalence of SR. ( J ALLERGY CLIN 1MMUNOL 1992;90:331-4.)

Field sting reactions in patients receiving Hymenoptera venom immunotherapy: real-life experience

Asian Pacific Journal of Allergy and Immunology, 2022

Background: Hymenoptera stings can cause systemic allergic reactions (SARs) that are prevented by venom immunotherapy (VIT). Sting challenge tests or field stings are used to evaluate the outcome of VIT. Objective: The aim of the study was to investigate the consequences of field stings in patients during or after completion of VIT, and to identify patients at higher risk. Methods: Patients treated with VIT between 1995 and 2018 were retrospectively evaluated. Contacted patients were invited to the clinic and a questionnaire was conducted regarding the history of field stings. Results: A total of 115 patients (F/M: 45/70, mean age: 38.5 ± 12 years) treated with VIT were included; 74/115 were contacted and asked about field stings after VIT cessation. A history of 73 field stings was reported in 38 patients, 25 of whom were treated with honeybee venom and 13 with common wasp venom. Eighteen of the reactions were SARs [8 with honeybees (1 grade-I, 6 grade-II, 1 grade-III) and 10 with common wasps (1 grade-I, 5 grade-II, 4 grade-III)]. There was no association between the severity of index reactions and field stings with either the honeybee or common wasp. The median duration of VIT was longer in patients showing no reaction than in patients with an SAR. Of the 7 patients on ACE inhibitors or beta-blockers, 1 asthmatic patient developed grade-II SAR due to field stings in the first year of VIT. Conclusion: This study confirms that VIT lasting at least 3 years is effective in preventing SARs after field stings.