Over- and underestimated parameters in severe Hymenoptera venom–induced anaphylaxis: Cardiovascular medication and absence of urticaria/angioedema

Stoevesandt, Johanna; Hain, Johannes; Kerstan, Andreas; Trautmann, Axel

doi:10.1016/j.jaci.2012.03.024

Cited by 105 publications

(104 citation statements)

References 41 publications

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“…An observational cohort study of patients with Hymenoptera venom anaphylaxis confirmed significant contributing factors to be: elevated baseline tryptase concentrations, older age, absence of urticaria or angioedema during anaphylaxis, and symptom onset within 5 min after a sting; however, in this study, no significant relationship with β-blocker use or angiotensin-converting enzyme (ACE) inhibitor use was identified [18]. …”

Section: Patient Risk Factorsmentioning

confidence: 79%

“…The importance of systemic mastocytosis as a risk factor for severe Hymenoptera sting-induced anaphylaxis and venom subcutaneous immunotherapy (SCIT)-induced anaphylaxis cannot be overemphasized [1,2,17,18]. The association between drug-induced anaphylaxis and undetected mast cell disease is not as strong; nevertheless, examination for skin signs of mast cell disorders and measurement of baseline tryptase concentrations is recommended in these patients [19].…”

Section: Patient Risk Factorsmentioning

confidence: 99%

See 1 more Smart Citation

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

Simons

Ardusso

Dimov

et al. 2013

Int Arch Allergy Immunol

244

181

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The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis are a widely disseminated and used resource for information about anaphylaxis. They focus on patients at risk, triggers, clinical diagnosis, treatment in health care settings, self-treatment in the community, and prevention of recurrences. Their unique strengths include a global perspective informed by prior research on the global availability of essentials for anaphylaxis assessment and management and a global agenda for anaphylaxis research. Additionally, detailed colored illustrations are linked to key concepts in the text [Simons et al.: J Allergy Clin Immunol 2011;127:593.e1-e22]. The recommendations in the original WAO Anaphylaxis Guidelines for management of anaphylaxis in health care settings and community settings were based on evidence published in peer-reviewed, indexed medical journals to the end of 2010. These recommendations remain unchanged and clinically relevant. An update of the evidence base was published in 2012 [Simons et al.: Curr Opin Allergy Clin Immunol 2012;12:389-399]. In 2012 and early 2013, major advances were reported in the following areas: further characterization of patient phenotypes; development of in vitro tests (for some allergens) that help distinguish clinical risk of anaphylaxis from asymptomatic sensitization; epinephrine (adrenaline) research, including studies of a new epinephrine auto-injector for use in community settings, and randomized controlled trials of immunotherapy to prevent food-induced anaphylaxis. Despite these advances, the need for additional prospective studies, including randomized controlled trials of interventions in anaphylaxis is increasingly apparent. This 2013 Update highlights publications from 2012 and 2013 that further contribute to the evidence base for the recommendations made in the original WAO Anaphylaxis Guidelines. Ideally, it should be used in conjunction with these Guidelines and with the 2012 Guidelines Update.

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Section: Patient Risk Factorsmentioning

confidence: 79%

Section: Patient Risk Factorsmentioning

confidence: 99%

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

Simons

Ardusso

Dimov

et al. 2013

Int Arch Allergy Immunol

244

181

View full text Add to dashboard Cite

show abstract

“…Thus, it appears the clonal MC disorder associated with venom sensitivity in adults is disparate from the limited data available in children. Further, it is well documented that cardiovascular symptoms in the absence of cutaneous symptoms is characteristic of anaphylaxis among adults suffering from clonal MC disorders [26,54,98]; however, data about these symptoms during anaphylaxis in pediatric mastocytosis are limited to some series where the children suffering anaphylaxis are a minority of the cases, and the symptoms presented during anaphylaxis for each case are not clearly reported (Table 1) [19,23,63,84]. All these data highlight the need for additional studies to document the actual incidence of IgE-mediated diseases in mastocytosis, as well as the prevalence, severity, and course of anaphylaxis in the pediatric population.…”

Section: Anaphylaxis In Pediatric Mastocytosismentioning

confidence: 99%

“…The overall incidence of anaphylaxis is reported to be more common in pediatric mastocytosis; however, previous studies in pediatric anaphylaxis have not noted this as a confounding factor. Further investigations to rule out an underlying clonal MC disorder would be recommended, as it is indicated in anaphylaxis in the adult population where associated cardiovascular symptoms-e.g., hypotension-emerging after a hymenoptera sting or unknown triggers are highly suspicious for an underlying clonal MC disorder, despite the absence of the typical skin lesions of mastocytosis [24,26,54,98].…”

Section: Anaphylaxis In Pediatric Mastocytosismentioning

confidence: 99%

Cutaneous and Systemic Mastocytosis in Children: A Risk Factor for Anaphylaxis?

Matito

Carter²

2015

Curr Allergy Asthma Rep

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Childhood mastocytosis is usually a clonal mast cell disease related to activating mutations in KIT. The symptoms in childhood mastocytosis are typically cutaneous in nature although systemic symptoms including anaphylaxis due to the release of mast cells (MC) mediators can also manifest. The prevalence of anaphylaxis reported in childhood mastocytosis is higher than the rates reported in the pediatric general population, but lower than the prevalence of anaphylaxis described in adult mastocytosis. An extensive cutaneous involvement was reported as a risk factor for anaphylaxis, and patients with diffuse cutaneous mastocytosis have been documented to have more severe anaphylaxis symptoms. Anaphylaxis due to unknown causes or idiopathic anaphylaxis was the primary etiology in pediatric mastocytosis, followed by foods as the most relevant identified trigger; however, hymenoptera stings are not a frequent trigger of anaphylaxis in children with mastocytosis in contrast to the adult patients.

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“…No relationship could be found between gender and the severity of anaphylaxis (P = 0.86). 23 Interpreting this result, the study's retrospective approach as well as the incompatibility of field stings and challenge sting, have to be considered as a disadvantage. A different view on that issue was presented in a recently published, multicenter prospective, European study of 962 Hymenoptera venom-sensitive patients.…”

Section: Gender and The Severity Of Hymenoptera Venom Allergymentioning

confidence: 99%

Sex-related clinical aspects in insect venom anaphylaxis

Nittner-Marszalska

Liebhart

Dor-Wojnarowska

2015

Int J Immunopathol Pharmacol

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Experimental studies, epidemiological data, and clinical observations suggest that the gender factor is involved in the development and manifestation of IgE-dependent allergic diseases. We intend to answer the question if sex-related factors may play a role in Hymenoptera venom allergy (HVA). In the majority of recent studies the frequency of HVA symptoms with respect to both LL and SYS reactions is similar for men and women, while proven sensitization to insect venom is less frequent in women. Studies assessing clinical reactivity in HVA indicate that male sex and vespid venom allergy are factors increasing the risk of severe allergic reactions. Regarding the risk of adverse events associated with gender in the course of venom immunotherapy (VIT), the results of two large EAACI multicenter studies are discordant. In the first study, women showed increased risk of VIT adverse events. In the latter, systemic allergic side effects were not associated with gender. Despite theoretical premises and certain clinical observations indicating an important role of estrogens in allergic diseases, their influence on stinging insects' venom hypersensitivity is not unequivocal and remains still open. Further studies on the safety of VIT in females seem to be advisable.

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Over- and underestimated parameters in severe Hymenoptera venom–induced anaphylaxis: Cardiovascular medication and absence of urticaria/angioedema

Cited by 105 publications

References 41 publications

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

Cutaneous and Systemic Mastocytosis in Children: A Risk Factor for Anaphylaxis?

Sex-related clinical aspects in insect venom anaphylaxis

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