Risk factors for severe systemic sting reactions in wasp (Vespula spp.) and honeybee (Apis mellifera) venom allergic patients

Abstract

Background Hymenoptera stings are a major cause of anaphylaxis. Various risk factors are discussed in literature. This study aims to investigate potential risk factors for severe sting reactions in wasp (Vespula spp.) and honeybee (Apis mellifera) venom allergic patients and analyses the correlation between diagnostic test results and the severity of the allergic reaction. Methods 480 patients suffering from wasp or honeybee venom allergy were included in this retrospective case series. Only individuals allergic to Vespula spp. but not to other vespids such as Polistes were considered. The severity of their systemic field sting reaction was analysed with regard to the amount of specific IgE antibodies to whole venom extracts and to major allergens of honeybee and/or wasp venom. Furthermore, the following potential risk factors for severe sting reactions were examined: age, sex, latency time, skin symptoms, baseline serum tryptase levels and the concentration of venom inducing a positive intracutaneous test. Results The two following indicators for severe systemic sting reactions in honeybee and wasp venom allergic patients have been identified: a short latency time and the absence of skin symptoms. The patient’s age and baseline serum tryptase levels have been found to positively correlate with the grade of the sting reaction only in individuals allergic to wasp venom. No correlation could be found between the degree of sensitisation and the severity of the allergic reaction. Neither the amount of specific IgE antibodies to whole venom extracts nor to major allergens were significantly associated with the severity of the sting reaction. Conclusion The clinical history is essential for the allergological workup and therapeutic decision on Hymenoptera venom allergies. A short latency time and the absence of skin symptoms are indicators for severe systemic sting reactions, followed by the patient’s age and baseline serum tryptase levels.

Comorbidities and Cofactors of Anaphylaxis in Patients with Moderate to Severe Anaphylaxis. Analysis of Data from the Anaphylaxis Registry for West Pomerania Province, Poland

“…Literature data indicate that in patients with anaphylaxis, the presence of cardiovascular disease has been shown to predispose them to fatalities [ 13 , 19 , 20 , 23 , 37 ], and it is probable that other chronic conditions such as renal and pulmonary problems would do likewise [ 59 ]. Concomitant cardiac conditions were an important predictor of severe anaphylaxis in the analysis of food-elicited reactions [ 35 ] and in patients with anaphylaxis induced by Hymenoptera venom [ 47 , 60 ], which is consistent with findings from our analysis. Recent medical history in elderly patients consisted of significantly more frequent cardiovascular, thyroid, and malignant diseases [ 61 ].…”

“…Current German and European guidelines recommend Venom Immunotherapy (VIT) for all patients with grade II or higher reactions and for patients with a grade 1 reaction if they have any other risk factors or if their quality of life has been negatively impacted [ 43 , 44 , 45 , 46 ]. Other risk factors for severe anaphylaxis triggered by insect sting include male sex, older age, a large number of stings, a short time interval between stings, the location of the sting, the absence of skin symptoms, high baseline serum tryptase levels, as well as cardiovascular comorbidity [ 47 ]. Oropeza et al [ 48 ] also reported other risk factors, such as asthma, rhinitis, atopic dermatitis, urticaria, and/or angioedema.…”

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

“…24 We recently determined that elderly patient experiencing anaphylaxis without concomitant skin symptoms tended to have more severe reactions. 25 Our findings are in concordance with those of a recent retrospective study from Fehr et al, 22 who identified lack of skin symptoms as a risk factor for severe VIA.…”

“…Previous studies also observed this phenomenon. 21,22 Subsequently, the correlation of BST levels with the severity of anaphylaxis led us to identify an interaction between the absence of skin symptoms and VIA by using generalized linear regression.…”

Highlights and recent developments in allergic diseases in EAACI journals (2019)

“…Risk factors for severe systemic sting reactions in wasp ( Vespula spp.) and honeybee ( Apis mellifera ) venom were examined in 480 allergic patients [ 89 ]. The clinical history is essential for the allergological workup and therapeutic decision on Hymenoptera venom allergies.…”