Management of occupational Hymenoptera allergy

Ruëff, Franziska; Châtelain, R; Przybilla, Bernhard

doi:10.1097/aci.0b013e3283445772

Cited by 18 publications

(19 citation statements)

References 34 publications

(38 reference statements)

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“…For prevention of recurrence of stinging insect venom-induced anaphylaxis, a 3-5 year course of subcutaneous immunotherapy with the relevant standardized specific venom(s) leads to long-lasting protection in most patients [2-4,14,112-115]; lifelong venom immunotherapy (VIT) is recommended in patients with mastocytosis [116]. …”

Section: Comparative Review Of Collaborating Organizations’ Principalmentioning

confidence: 99%

International consensus on (ICON) anaphylaxis

Simons

Ardusso

Bilò

et al. 2014

World Allergy Organization Journal

403

379

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ICON: Anaphylaxis provides a unique perspective on the principal evidence-based anaphylaxis guidelines developed and published independently from 2010 through 2014 by four allergy/immunology organizations. These guidelines concur with regard to the clinical features that indicate a likely diagnosis of anaphylaxis -- a life-threatening generalized or systemic allergic or hypersensitivity reaction.They also concur about prompt initial treatment with intramuscular injection of epinephrine (adrenaline) in the mid-outer thigh, positioning the patient supine (semi-reclining if dyspneic or vomiting), calling for help, and when indicated, providing supplemental oxygen, intravenous fluid resuscitation and cardiopulmonary resuscitation, along with concomitant monitoring of vital signs and oxygenation. Additionally, they concur that H1-antihistamines, H2-antihistamines, and glucocorticoids are not initial medications of choice.For self-management of patients at risk of anaphylaxis in community settings, they recommend carrying epinephrine auto-injectors and personalized emergency action plans, as well as follow-up with a physician (ideally an allergy/immunology specialist) to help prevent anaphylaxis recurrences.ICON: Anaphylaxis describes unmet needs in anaphylaxis, noting that although epinephrine in 1 mg/mL ampules is available worldwide, other essentials, including supplemental oxygen, intravenous fluid resuscitation, and epinephrine auto-injectors are not universally available.ICON: Anaphylaxis proposes a comprehensive international research agenda that calls for additional prospective studies of anaphylaxis epidemiology, patient risk factors and co-factors, triggers, clinical criteria for diagnosis, randomized controlled trials of therapeutic interventions, and measures to prevent anaphylaxis recurrences. It also calls for facilitation of global collaborations in anaphylaxis research.In addition to confirming the alignment of major anaphylaxis guidelines, ICON: Anaphylaxis adds value by including summary tables and citing 130 key references. It is published as an information resource about anaphylaxis for worldwide use by healthcare professionals, academics, policy-makers, patients, caregivers, and the public.

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Section: Comparative Review Of Collaborating Organizations’ Principalmentioning

confidence: 99%

International consensus on (ICON) anaphylaxis

Simons

Ardusso

Bilò

et al. 2014

World Allergy Organization Journal

403

379

View full text Add to dashboard Cite

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“…Patients who were lost to follow-up were not in- any of the above, plus 2 or more of the following: dyspnoea, wheezing, stridor, dysphagia, dysarthria, hoarseness, weakness, confusion and fear of death Systemic reaction grade IV any of the above plus 2 or more of the following: a drop in blood pressure, collapse, loss of consciousness, incontinence (urine or stools), cyanosis Table 2. Risk factors for a severe reaction to a hymenoptera sting [18,19,22,25,26] History of a prior severe sting reaction (with respiratory or cardiovascular symptoms) Vespid venom allergy (for field stings) Time interval between stings (<5 years) Elevated serum tryptase, mastocytosis Preexisting diseases (e.g. cardiovascular or asthma) Drugs (e.g.…”

Section: Study Design and Patient Selectionmentioning

confidence: 99%

“…While the former issue has been extensively investigated, data regarding exposure risk is poor. Occupation, leisure activity, residence, age and sex have been described as influencing the exposure risk [9,[18][19][20][21][22] . Furthermore, a personal history of an anaphylactic sting reaction also affects exposure risk as the fear of a future allergic reaction induces behavioral changes associated with avoidance measures [8] .…”

Section: Introductionmentioning

confidence: 99%

Risk Assessment of Hymenoptera Re-Sting Frequency: Implications for Decision-Making in Venom Immunotherapy

Moos

Graf²,

Johansen³

et al. 2012

Int Arch Allergy Immunol

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BACKGROUND: Venom immunotherapy is highly efficacious in preventing anaphylactic sting reactions. However, there is an ongoing discussion regarding patient selection and whether and how to apply a cost-benefit analysis of venom immunotherapy. In order to help decision-making, we investigated the re-sting frequency of hymenoptera-venom-allergic patients to single out those at high risk. METHODS: In this retrospective study, re-sting data of 96 bee-venom-allergic patients and 95 vespidvenom-allergic patients living mainly in a rural area of Switzerland were analyzed. Hymenoptera venom allergy status was rated according to the classification system of H.L. Mueller [J Asthma Res 1966;3:331-333]. Different risk-groups were defined according to sting exposure and their median sting-free interval was calculated. RESULTS: The risk factors for a wasp or bee re-sting were outdoor occupation, beekeeping and habitation close to a bee-house. Half of all vespid-venom-allergic outdoor workers were re-stung within 3.75 years compared to 7.5 years for indoor workers. Similarly, 50% of the bee-venom-allergic beekeepers or subjects with a bee-house in the vicinity suffered a bee re-sting within 5.25 years compared to 10.75 years for individuals who were not beekeepers. CONCLUSIONS: The high degree of exposure of vespid-venom-allergic outdoor workers and bee-venom-allergic beekeepers and subjects living close to bee-houses underlines the high benefit of venom immunotherapy for these patients even if they suffered a non-life-threatening grade II reaction. Yet, bee-venom-allergic individuals with no proximity to beehouses and with an indoor occupation face a very low exposure risk, which justifies epinephrine rescue treatment for these patients especially if they have suffered from grade II sting reactions. beekeepers or subjects with a bee-house in the vicinity suffered a bee re-sting within 5.25 years compared to 10.75 years for individuals who were not beekeepers. Conclusions: The high degree of exposure of vespid-venom-allergic outdoor workers and bee-venom-allergic beekeepers and subjects living close to bee-houses underlines the high benefit of venom immunotherapy for these patients even if they suffered a non-life-threatening grade II reaction. Yet, bee-venom-allergic individuals with no proximity to beehouses and with an indoor occupation face a very low exposure risk, which justifies epinephrine rescue treatment for these patients especially if they have suffered from grade II sting reactions.

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“…Outdoor workers (e.g. According to current European guidelines [42], VIT is recommended only for patients with a history of moderate-to-severe reactions, but it should be considered, even if there are contraindications, also for patients with a history of a very severe reaction who have the intention to continue their professional activity [40]. A recent Cochrane Review [41] confirmed that venom immunotherapy (VIT) is an effective therapy for preventing further allergic reactions to insect sting, and carries a small but significant risk of systemic adverse reaction.…”

Section: Hymenopteramentioning

confidence: 99%