Phenotype and risk factors of venom-induced anaphylaxis: A case-control study of the European Anaphylaxis Registry

Francuzik, Wojciech; Ruëff, Franziska; Bauer, Andrea; Bilò, Maria Beatrice; Cardona, Victòria; Christoff, George; Dölle‐Bierke, Sabine; Ensina, Luis Felipe; Hawranek, Thomas; Hourihane, Jonathan; Jakob, Thilo; Papadopoulos, Nikolaos; Pföhler, Claudia; Poziomkowska-Gęsicka, Iwona; Brempt, X. Van Der; Scherer, Kathrin; Treudler, Regina; Wagner, Nicola; Wedi, Bettina; Worm, Margitta

doi:10.1016/j.jaci.2020.06.008

Cited by 52 publications

(47 citation statements)

References 31 publications

(33 reference statements)

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“…Whereas previous studies have suggested that BST levels of at least 5 ng/mL 13 to 8 ng/mL 12,14 are associated with a higher risk of severe anaphylactic reactions, our data show that using even these cutoffs below what is considered an elevated BST level (>11.4 ng/mL) would miss the majority of individuals with clonal MC disease who are at high risk of severe anaphylaxis. Taken together, our data demonstrate that KIT p.D816V is the major testable risk factor for severe anaphylaxis among individuals with CVD, Cardiovascular disease.…”

Section: Resultscontrasting

confidence: 99%

Routine KIT p.D816V screening identifies clonal mast cell disease in patients with Hymenoptera allergy regularly missed using baseline tryptase levels alone

Šelb

Rijavec

Eržen

et al. 2021

Journal of Allergy and Clinical Immunology

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Section: Resultscontrasting

confidence: 99%

Routine KIT p.D816V screening identifies clonal mast cell disease in patients with Hymenoptera allergy regularly missed using baseline tryptase levels alone

Šelb

Rijavec

Eržen

et al. 2021

Journal of Allergy and Clinical Immunology

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“…This is in conflict with data from the anaphylaxis registry of the German‐speaking countries: In the first report, 17 a moderately increased risk for more severe anaphylaxis particularly in patients taking both, β‐blockers and ACEI, was detected. More recently, 31 it was reported that patients receiving β‐blockers and ACEI had a higher risk of developing severe cardiovascular symptoms during venom‐induced anaphylaxis. There may be several reasons explaining the different findings.…”

Section: Discussionmentioning

confidence: 99%

β‐blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy

Sturm

Herzog

Aberer

et al. 2021

Allergy

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Background There is controversy whether taking β‐blockers or ACE inhibitors (ACEI) is a risk factor for more severe systemic insect sting reactions (SSR) and whether it increases the number or severity of adverse events (AE) during venom immunotherapy (VIT). Methods In this open, prospective, observational, multicenter trial, we recruited patients with a history of a SSR and indication for VIT. The primary objective of this study was to evaluate whether patients taking β‐blockers or ACEI show more systemic AE during VIT compared to patients without such treatment. Results In total, 1,425 patients were enrolled and VIT was performed in 1,342 patients. Of all patients included, 388 (27.2%) took antihypertensive (AHT) drugs (10.4% took β‐blockers, 11.9% ACEI, 5.0% β‐blockers and ACEI). Only 5.6% of patients under AHT treatment experienced systemic AE during VIT as compared with 7.4% of patients without these drugs (OR: 0.74, 95% CI: 0.43–1.22, p = 0.25). The severity of the initial sting reaction was not affected by the intake of β‐blockers or ACEI (OR: 1.14, 95% CI: 0.89–1.46, p = 0.29). In total, 210 (17.7%) patients were re‐stung during VIT and 191 (91.0%) tolerated the sting without systemic symptoms. Of the 19 patients with VIT treatment failure, 4 took β‐blockers, none an ACEI. Conclusions This trial provides robust evidence that taking β‐blockers or ACEI does neither increase the frequency of systemic AE during VIT nor aggravate SSR. Moreover, results suggest that these drugs do not impair effectiveness of VIT. (Funded by Medical University of Graz, Austria; Clinicaltrials.gov number, NCT04269629).

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“…A report based on the Beijing Pharmacovigilance Database (2004-2014) showed that children of 0-5 years were more likely to develop cyanosis than children of [38]. The EAR case control study of the VIA (n = 3,612, including 20% of patients younger than 22 years) and non-VIA (n = 3,605) patients matched for age and gender demonstrated that hypotension was a predominant manifestation in any age VIA group when compared to either other non-VIA triggers or symptoms of different body systems [13]. There were episodic incidents of drug-induced perioperative anaphylaxis reported in children, which compromised a total of 29 cases from the UK, USA and France (average age: 11 years) during a 10-year period [39].…”

Section: Phenotypesmentioning

confidence: 99%

The 2020 update on anaphylaxis in paediatric population

Tarczoń¹,

Cichocka‐Jarosz²,

Knapp³

et al. 2022

pdia

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The objective of the review is to present recent updates on anaphylaxis in paediatric population worldwide. The article summarizes the results of epidemiological studies, diagnostic methods and treatments. We present a new WAO definition of anaphylaxis (2019), which broader criteria excluding dermal symptoms should facilitate faster lifesaving adrenaline use. Adrenaline remains the best treatment to manage severe symptoms and to prevent biphasic reactions. There is ongoing effort to increase adrenaline use, such as modified autoinjectors, individual training, and diversified dosing. There are five independent risk factors of lethal anaphylaxis in children, including history of asthma, almost immediate onset of symptoms, unwell appearance, tachycardia and hypotension. We also report improvements in diagnostics, like component-resolved diagnostics, and novel therapies stimulating immunotolerance. We signal the development of ICD-11 with updated coding of anaphylaxis, which corresponds better to clinical observations.

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Phenotype and risk factors of venom-induced anaphylaxis: A case-control study of the European Anaphylaxis Registry

Cited by 52 publications

References 31 publications

Routine KIT p.D816V screening identifies clonal mast cell disease in patients with Hymenoptera allergy regularly missed using baseline tryptase levels alone

Routine KIT p.D816V screening identifies clonal mast cell disease in patients with Hymenoptera allergy regularly missed using baseline tryptase levels alone

β‐blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy

The 2020 update on anaphylaxis in paediatric population

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