Pre-hospital treatment of bee and wasp induced anaphylactic reactions: a retrospective study

Liao

et al. 2020

Insects

Envenoming syndrome is a systemic reaction induced by inoculation of large volumes of Hymenoptera venom. The clinical manifestations range from skin allergic reactions to multiple organ failure. Vespid venom-induced toxic reactions and anaphylaxis are the most common lethal mechanism of death, involving acute respiratory failure, acute liver failure, rhabdomyolysis, acute kidney injury, and severe coagulopathy. Multiple organ failure as a consequence of severe venom toxicity is a rare but dangerous complication in victims. Delay of intervention to correct vespid venom-induced toxic reactions may cause catastrophic complications. Here, we describe a case presenting a rare vespid venom-induced multiple organ failure with systemic coagulopathy after massive Vespa attack.

Section: Discussionmentioning

confidence: 99%

“…Conditions in which epinephrine injection is recommended include the sensation of throat pruritus, difficulty swallowing, dyspnea, dysrhythmia, hypotension, and loss of consciousness. Early administration of epinephrine should be considered in patients with a Sampson's severity score of more than grade 3 [3].…”

Section: Discussionmentioning

confidence: 99%

An Envenoming Syndrome from Massive Vespa Stings Induces Multiple Organ Failure

Liao

et al. 2020

Insects

Scand J Trauma Resusc Emerg Med

“…The severity of the anaphylactic reaction was graduated according to Sampson’s severity score [ 17 ], the severity score that is used routinely in our AC [ 18 ]. It consists of five severity grades; from grade 1, mild symptoms, to grade 5 severe symptoms.…”

Section: Methodsmentioning

confidence: 99%

Anaphylaxis in an emergency care setting: a one year prospective study in children and adults

Oropeza

Lassen

Halken

et al. 2017

Self Cite

BackgroundCurrent data on anaphylaxis is based on retrospective and register based studies. The objective of this study was to describe the epidemiology of anaphylaxis in a 1 year prospective study at the emergency care setting, Odense University Hospital, Denmark (2013–2014).MethodsProspective study at the emergency care setting, Odense University Hospital, Denmark (2013–2014). To identify anaphylaxis cases, records from all patients with clinical suspicion on anaphylaxis or a related diagnosis according to the International Classification of Diseases 10 and from patients treated at the emergency care setting or at prehospital level with adrenaline, antihistamines or glucocorticoids were reviewed daily. The identified cases were referred to the Allergy Center, where a standardized interview regarding the anaphylactic reaction was conducted. International guidelines were applied for the assessment of anaphylaxis and its pharmacological treatment. Severity of the anaphylactic reaction was evaluated according to Sampson’s severity score.ResultsWe identified 180 anaphylactic patients. Anaphylaxis represented 0.3%–0.4% of all contacts in the emergency care setting with an incidence rate of 26.8 cases per 100,000 person years (95% CI: 14.3–45.8) in children and 40.4 cases per 100,000 person years (95% CI: 32.8–49.3) in adults. Moderate to severe anaphylaxis was registered in 96% of the cases. Skin (96%) and respiratory (79%) symptoms were the most frequent registered, but 7% of cases in adults occurred without skin manifestations. The most common elicitor in children was food (61%), while drugs (48%) and venom (24%) were the main suspected elicitors in adults. Adrenaline was administered in 25% of the cases and it was significantly less administered than glucocorticoids (83%) and antihistamines (91%). The mortality rate during our study period was 0.3 cases per 100,000 person years.DiscussionThis is one of the first prospective studies on the epidemiology of anaphylaxis in children and adults, where the patients are identified not only based on diagnosis codes but also on history, symptoms and treatment and thereafter classified according to international diagnosis criteria for anaphylaxis.A limitation of this study is that only patients who gave consent to participate in the study were included. Furthermore, patients may have attended other hospitals during the study period. Therefore, the estimates are minimum figures.ConclusionThe prospective study design with a broad search profile yield a higher incidence than previously reported. Adrenaline was administered in a low proportion of the patients with moderate to severe anaphylaxis. Standardized diagnosis criteria among physicians treating anaphylaxis are needed.

“…The patient received adrenaline, the treatment of choice, which is used to block the cascade of mediators regardless of the pathophysiological mechanism [4]. However, the administration was not immediate, a situation often observed for anaphylaxis [5]. Prehospital administration is possible in developed countries with self-injectable syringes which are not available in our context.…”

Section: Discussionmentioning

confidence: 99%

Deadly Envenomation by Massive Bee Stings in a 7-Year Old Child in Ouagadougou

Ouédraogo¹,

Yonaba²,

Kalmogho³

et al. 2017

OJPed

Introduction: We are reporting a deadly case of massive bee stings observed in a 7-year-old child in Ouagadougou. Observation: The first symptoms, which appeared two hours after the stings of about 200 bees, motivated a consultation in a nearby dispensary in which the child received intravenous betamethasone before being referred to the University Hospital Center Yalgado Ouédraogo (CHUYO). Seven hours after the accident, a rapid deterioration in the general condition was noted with hemorrhage, respiratory distress, coma, and shock. A grade 3 anaphylaxis was diagnosed. The patient didn't survive despite of the cardiopulmonary resuscitation using adrenaline in intensive care. Conclusion: The massive bee stings have caused a severe biphasic anaphylactic reaction which could not be reversed by the adrenaline administered in the second phase. The development of a protocol would contribute to a better management of the cases.