Diagnosis and treatment of anaphylactic reactions to Hymenoptera stings in children

Chipps, Bradley E.; Valentine, Martin D.; Kagey‐Sobotka, Anne; Schuberth, Kenneth C.; Lichtenstein, Lawrence M.

doi:10.1016/s0022-3476(80)80470-7

Cited by 58 publications

(24 citation statements)

References 25 publications

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“…Observation of children with insect allergy has led to the perception of milder clinical presentations with a much higher frequency of isolated cutaneous reactions and a lower frequency of severe cardiovascular symptoms, compared to adults [19,25,26]. Different classifications for defining severe SRs may lead to varying results; however, the frequency of SRs against wasp (56.9%) and bee venom (66.7%) was relatively high in our study population when compared to previous studies.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features of Children with Venom Allergy and Risk Factors for Severe Systemic Reactions

Yavuz

Şahiner²,

Büyüktiryaki³

et al. 2012

Int Arch Allergy Immunol

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Background: Severe systemic reactions (SRs) to insect venom are rare in childhood and there are few data on this study population. The aim of our study is to analyze the clinical features and to document the risk factors for severe SRs in children with insect venom allergy. Methods: Children with SRs after Hymenoptera sting were analyzed. The diagnosis was based on medical history, skin tests and/or specific IgE testing. Results: Seventy-six children were included [57 boys (75%), mean age 9.8 ± 3.4 years]. The mean age of children at the time of SR was 8.3 ± 3.4 years. Reactions were accounted for Vespula (wasp) venom in 58 (76%) and Apis mellifera (bee) venom in 18 (24%) patients. Twenty-six percent of patients had aeroallergen sensitization and 33% had atopic disease, whereas 66% had experienced previous stings. The upper limb was the most frequent area of sting (43%), and the cutaneous system (99%) was the most frequent involved system. SRs occurred in 59% of patients. Multivariate logistic regression analysis revealed eosinophilia (>5%) [odds ratio (OR) 12.6; confidence interval (CI) 1.5–109.7; p = 0.022], female sex (OR 6.4; CI 1.5–26.9; p = 0.011) and accompanying atopic disease (OR 3.4; CI 1.2–12.3; p = 0.016) as significant risk factors for severe SRs. Ninety-seven percent of patients were admitted to the emergency department; however, epinephrine was used in only 46% of patients. Conclusions: There was a high frequency of hypersensitivity to wasp venom among the study population, and severe reactions were related to mild eosinophilia, female sex and concomitant atopic diseases. A better understanding of the risk factors may lead to effective utilization of health care sources in the future.

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Section: Discussionmentioning

confidence: 99%

Clinical Features of Children with Venom Allergy and Risk Factors for Severe Systemic Reactions

Yavuz

Şahiner²,

Büyüktiryaki³

et al. 2012

Int Arch Allergy Immunol

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“…Bislang gibt es wenige Daten über wiederholte Stichprovokationen bei Patienten während fortgesetzter HG-SIT. Wiederholte Stichprovokationen wurden vorwiegend bei Kindern und Jugendlichen durchgeführt und zeigten eine hundertprozentige Reproduzierbarkeit vertragener Stichprovokationen [4,10,12,24]. In einer eigenen Untersuchung an erwachsenen Patienten nach vertragener Stichprovokation wurde der Ausgang von Feldstichen wäh-rend weiter fortgesetzter HG-SIT untersucht.…”

Section: Zuverlässigkeit Der Stichprovokationunclassified

Stichprovokation

Ruëff

Przybilla²

2014

Hautarzt

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For the majority of patients quality of life will significantly improve after tolerated sting challenge. A sting challenge test is particularly important in those patients who are at increased risk due their increased risk of treatment failure. If in patients with risk factors for treatment failure, VIT is done with elevated dose or if no risk factors are present, a sting challenge may not be needed. VIT with an elevated dose may prevent or correct treatment failure.

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“…Successful desensitization was projected based on the following rationale: for patients undergoing immunotherapy for clinical sen sitivity to bee venom it is generally accepted that tol erance of 100 ug of bee venom correlates well with clinical protection. Initial studies reported that the ef ficacy rate, based on post-immunotherapy challenge stings in hospital, is 97% [3,4). In the analysis of our data we assume that achievement of 100 ug dose of bee venom during immunotherapy is equivalent (97%) to clinical protection.…”

mentioning

confidence: 87%

Histamine-Binding Lymphocytes as a Measure of Reactivity to Bee Venom

Ruby

Czarny²,

Hk³

1988

Int Arch Allergy Immunol

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Reduced lymphocyte histamine-binding after in vitro exposure of whole blood samples to bee venom appears related to allergen reactivity. The reactivity demonstrated using this method matched the clinical findings and was used to monitor declining responses to allergen during desensitization therapy for hypersensitivity to bee venom. After successful desensitization to bee venom, patients’ lymphocytes did not show decreased histamine binding following in vitro exposure to venom. We conclude that lymphocyte histamine-binding sites are down-regulated by allergen-mediated histamine release in hypersensitive subjects, and that this response diminishes with immunotherapy. This report describes a novel method for the in vitro assessment of reactivity to bee venom.

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Diagnosis and treatment of anaphylactic reactions to Hymenoptera stings in children

Cited by 58 publications

References 25 publications

Clinical Features of Children with Venom Allergy and Risk Factors for Severe Systemic Reactions

Clinical Features of Children with Venom Allergy and Risk Factors for Severe Systemic Reactions

Stichprovokation

Histamine-Binding Lymphocytes as a Measure of Reactivity to Bee Venom

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