Stinging insect hypersensitivity: A practice parameter update

Moffitt, John E.; Golden, David B.K.; Reisman, Robert E.; Lee, Rufus; Nicklas, Richard A.; Freeman, Theodore M.; deShazo, Richard D.; Tracy, James M.; Bernstein, I. Leonard; Blessing-Moore, Joann; Khan, David A.; Lang, David M.; Portnoy, Jay M.; Schuller, Diane E.; Spector, Sheldon L.; Tilles, Steven A.

doi:10.1016/j.jaci.2004.07.046

Cited by 219 publications

(150 citation statements)

References 82 publications

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“…On the other hand, anaphylaxis due to sting challenges has been reported in patients with venom-specific IgE or skin test conversion (21,(23)(24)(25)(26). Therefore, current practice is to offer VIT for a finite period of 3-5 years, irrespective the persistence of a positive skin test or IgE result (32)(33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

Flow‐assisted quantification of in vitro activated basophils in the diagnosis of wasp venom allergy and follow‐up of wasp venom immunotherapy

Ebo

Hagendorens

Schuerwegh

et al. 2006

Cytometry Part B Clinical

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Background: Correct identification of the culprit venom is a prerequisite for specific venom immunotherapy (VIT). Despite the efficacy of VIT, issues as how to monitor treatment and when to discontinue maintenance therapy remain to be established.Methods: To evaluate diagnostic performances of the basophil activation test (BAT) in wasp venom allergy, 80 patients with a definite history of wasp venom anaphylaxis (systemic reactors) and 14 waspstung asymptomatic controls (stung controls) were enrolled. Venom-induced basophil activation was analyzed flow cytometrically by double-labeling with anti-IgE and anti-CD63. Results were compared to wasp IgE levels and results of a venom skin test (VST). To establish whether the BAT constitutes a candidate marker to monitor VIT, the BAT was repeated in 22 patients on the 5th day of a build-up course and after 6 months of maintenance VIT. Whether the BAT could contribute in the decision of discontinuing VIT was assessed in a cross-sectional analysis in 30 patients receiving treatment for 3 years.Results: Comparison between systemic reactors and stung controls revealed a sensitivity of 86.4% and specificity of 100% for venom IgE, and sensitivity of 81.8% for VST, respectively. In contrast to stung controls, patients demonstrated dose-dependent venom-induced basophil activation. The BAT attained a sensitivity of 83.8% and specificity of 100%. At the end of the build-up course, no effect of VIT on the BAT was demonstrable. When the BAT was repeated after 6 months of treatment, submaximal stimulation of the cells demonstrated a significant decreased CD63 expression (P < 0.04). Patients having VIT for 3 years also demonstrated significantly lower venom-induced CD63 expression (P < 0.001). After 3 years, 60% of the patients had a negative BAT for submaximal stimulation of the cells whereas only 17.9% of the patients had negativation of wasp IgE.Conclusions: The BAT is a reliable instrument for the diagnosis of wasp venom anaphylaxis and might constitute an instrument to monitor wasp VIT. q

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Section: Discussionmentioning

confidence: 99%

Flow‐assisted quantification of in vitro activated basophils in the diagnosis of wasp venom allergy and follow‐up of wasp venom immunotherapy

Ebo

Hagendorens

Schuerwegh

et al. 2006

Cytometry Part B Clinical

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“…However, on the basis of available evidence, self-injectable epinephrine should be prescribed for a child who has experienced generalized acute urticaria after an insect sting, because the risk of a more severe reaction from a future sting is approximately 10%. 33 Finally, physicians cannot assume that patients and caregivers necessarily recognize and report all symptoms, because even trained health care professionals underrecognize anaphylaxis. 2 For all of these reasons, a high index of suspicion is needed to identify those who have had anaphylaxis and require an epinephrine prescription.…”

Section: Prescription Of Self-injectable Epinephrinementioning

confidence: 99%

Self-injectable Epinephrine for First-Aid Management of Anaphylaxis

Sicherer¹,

Simons²

2007

Pediatrics

166

129

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Anaphylaxis is a severe, potentially fatal systemic allergic reaction that is rapid in onset and may cause death. Epinephrine is the primary medical therapy, and it must be administered promptly. This clinical report focuses on practical issues concerning the administration of self-injectable epinephrine for first-aid treatment of anaphylaxis in the community. The recommended epinephrine dose for anaphylaxis in children, based primarily on anecdotal evidence, is 0.01 mg/kg, up to 0.30 mg. Intramuscular injection of epinephrine into the lateral thigh (vastus lateralis) is the preferred route for therapy in first-aid treatment. Epinephrine autoinjectors are currently available in only 2 fixed doses: 0.15 and 0.30 mg. On the basis of current, albeit limited, data, it seems reasonable to recommend autoinjectors with 0.15 mg of epinephrine for otherwise healthy young children who weigh 10 to 25 kg (22-55 lb) and autoinjectors with 0.30 mg of epinephrine for those who weigh approximately 25 kg (55 lb) or more; however, specific clinical circumstances must be considered in these decisions. This report also describes several quandaries in regard to management, including the selection of dose, indications for prescribing an autoinjector, and decisions regarding when to inject epinephrine. Effective care for individuals at risk of anaphylaxis requires a comprehensive management approach involving families, allergic children, schools, camps, and other youth organizations. Risk reduction entails confirmation of the trigger, discussion of avoidance of the relevant allergen, a written individualized emergency anaphylaxis action plan, and education of supervising adults with regard to recognition and treatment of anaphylaxis.

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“…It is the only specific treatment for hymenoptera venom anaphylaxis [19][20][21]. Various venom immunotherapy schedules have been designed to treat anaphylaxis [22][23][24][25][26][27]. Though the effect of venom immunotherapy is well documented, there is also an increased risk of side-effects that were in a large range from itchy eyes, sneezing to Jessner lymphocytic infiltrate and severe anaphylaxis in bee-venom-treated patients and in those with rapid dose increase [28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Omalizumab: Anti-IgE Therapy in Severe Allergic Conditions

Yalçın¹

2012

J Aller Ther

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Background: The primary use of omalizumab (trade name Xolair) is for patients with severe, persistent and allergic asthma. Our aim was to evaluate the therapeutic efficacy of omalizumab as a treatment modality in patients with different allergic conditions. Methods: There were eleven patients, whom followed-up with omalizumab therapy in the Immunology -Allergy Clinic, were evaluated by the clinical findings of nasal polyposis, anaphylaxis history, drug allergy, latex allergy, food allergy, autoimmune urticaria, allergic rhino-conjunctivitis, atopic dermatitis, angioedema and venom allergy. Results:The patients, who had severe persistent asthma for periods ranging from 3 to 8 years, were enrolled in the study. Omalizumab was chosen as a potential new systemic therapy for the patients due to the clinical indication. Clinical symptoms of the all patients with severe persistent asthma were decreased. And in addition, asthma control test and pulmonary function tests were improved up. A severe anaphylactic reaction is prevented in a patient with 48 bee stings. Conclusion:This clinical follow-up of omalizumab treated patients with severe persistent asthma and many different allergic conditions, suggests omalizumab is an effective therapy for asthma and different allergic conditions.

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Stinging insect hypersensitivity: A practice parameter update

Cited by 219 publications

References 82 publications

Flow‐assisted quantification of in vitro activated basophils in the diagnosis of wasp venom allergy and follow‐up of wasp venom immunotherapy

Flow‐assisted quantification of in vitro activated basophils in the diagnosis of wasp venom allergy and follow‐up of wasp venom immunotherapy

Self-injectable Epinephrine for First-Aid Management of Anaphylaxis

Omalizumab: Anti-IgE Therapy in Severe Allergic Conditions

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