Document Detail

Over- and underestimated parameters in severe Hymenoptera venom-induced anaphylaxis: cardiovascular medication and absence of urticaria/angioedema.
MedLine Citation:
PMID:  22554708     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Severe anaphylaxis in Hymenoptera venom allergy has been associated with a number of risk factors including elevation of baseline serum tryptase (BST), older age, concomitant diseases, and concurrent medication.
OBJECTIVE: The aim of this study was to evaluate indicators and risk factors for severe anaphylaxis due to Hymenoptera field stings with an emphasis on details related to the sting reaction and concurrent medication.
METHODS: In this single-center observational cohort study, we included 657 consecutive patients fulfilling the criteria for venom immunotherapy. Severity of sting-induced anaphylaxis was analyzed in relation to patient-specific risk factors (age and sex, preexisting cardiopulmonary conditions, cardiovascular medication) and details related to the sting reaction (culprit insect, localization of the sting, time interval to onset of symptoms, and presence or absence of cutaneous involvement). BST was determined in a subgroup of patients with moderate to severe anaphylaxis.
RESULTS: Four significant indicators and risk factors of severe anaphylaxis were identified (P < .001): (1) elevation of BST, (2) absence of urticaria or angioedema during anaphylaxis, (3) time interval of less than 5 minutes from sting to onset of symptoms, and (4) senior age. The absence of urticaria/angioedema is significantly related to BST elevation (P = .02). No relationship could be established between the severity of anaphylaxis and comorbidities or concurrent cardiovascular medication.
CONCLUSIONS: Absence of urticaria/angioedema is an indicator of severe anaphylaxis and possibly mastocytosis, requiring determination of BST. Study data do not provide evidence for an aggravation of sting-induced anaphylaxis by concurrent beta-blockade or angiotensin-converting enzyme inhibition.
Johanna Stoevesandt; Johannes Hain; Andreas Kerstan; Axel Trautmann
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Publication Detail:
Type:  Journal Article     Date:  2012-05-01
Journal Detail:
Title:  The Journal of allergy and clinical immunology     Volume:  130     ISSN:  1097-6825     ISO Abbreviation:  J. Allergy Clin. Immunol.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-31     Completed Date:  2012-11-07     Revised Date:  2013-03-14    
Medline Journal Info:
Nlm Unique ID:  1275002     Medline TA:  J Allergy Clin Immunol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  698-704.e1     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
Department of Dermatology, Venereology, and Allergology, University of Würzburg, Würzburg, Germany.
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MeSH Terms
Age Factors
Aged, 80 and over
Anaphylaxis / etiology*
Angioedema / complications
Arthropod Venoms / immunology*
Cardiovascular Agents / adverse effects*
Cohort Studies
Hymenoptera / immunology*
Insect Bites and Stings / complications
Middle Aged
Reaction Time
Risk Factors
Time Factors
Tryptases / blood
Urticaria / complications
Reg. No./Substance:
0/Arthropod Venoms; 0/Cardiovascular Agents; EC
Comment In:
J Allergy Clin Immunol. 2013 Feb;131(2):614-5   [PMID:  23273956 ]
J Allergy Clin Immunol. 2013 Feb;131(2):615-6   [PMID:  23273950 ]

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