Venom immunotherapy reduces large local reactions to insect stings

Golden, David B.K.; Kelly, D.; Hamilton, Robert G.; Craig, Timothy J.

doi:10.1016/j.jaci.2009.03.017

Cited by 90 publications

(39 citation statements)

References 24 publications

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“…52,124 It also reduces large local reactions to stings and might be considered for at-risk patients who cannot totally avoid insect exposure, such as beekeepers, and/or those who experience frequent or severe large local reactions. 150 In children, venom immunotherapy is not indicated either for sting-induced generalized urticaria without other systemic symptoms or for large local reactions (Table IX). 145 Anaphylaxis induced by other triggers.…”

Section: Long-term Risk Reduction: Prevention Of Anaphylaxismentioning

confidence: 99%

Anaphylaxis

Simons

2010

Journal of Allergy and Clinical Immunology

394

380

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Anaphylaxis occurs commonly in community settings. The rate of occurrence is increasing, especially in young people. Understanding potential triggers, mechanisms, and patient-specific risk factors for severity and fatality is the key to performing appropriate risk assessment in those who have previously experienced an acute anaphylactic episode. The diagnosis of anaphylaxis is based primarily on clinical criteria and is valid even if the results of laboratory tests, such as serum total tryptase levels, are within normal limits. Positive skin test results or increased serum specific IgE levels to potential triggering allergens confirm sensitization but do not confirm the diagnosis of anaphylaxis because asymptomatic sensitization is common in the general population. Important patient-related risk factors for severity and fatality include age, concomitant diseases, and concurrent medications, as well as other less well-defined factors, such as defects in mediator degradation pathways, fever, acute infection, menses, emotional stress, and disruption of routine. Prevention of anaphylaxis depends primarily on optimal management of patient-related risk factors, strict avoidance of confirmed relevant allergen or other triggers, and, where indicated, immunomodulation (eg, subcutaneous venom immunotherapy to prevent Hymenoptera sting-triggered anaphylaxis, an underused, potentially curative treatment). The benefits and risks of immunomodulation to prevent food-triggered anaphylaxis are still being defined. Epinephrine (adrenaline) is the medication of first choice in the treatment of anaphylaxis. All patients at risk for recurrence in the community should be equipped with 1 or more epinephrine autoinjectors; a written, personalized anaphylaxis emergency action plan; and up-to-date medical identification. Improvements in the design of epinephrine autoinjectors will help to optimize ease of use and safety. Randomized controlled trials of pharmacologic agents, such as antihistamines and glucocorticoids, are needed to strengthen the evidence base for treatment of acute anaphylactic episodes.

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Section: Long-term Risk Reduction: Prevention Of Anaphylaxismentioning

confidence: 99%

Anaphylaxis

Simons

2010

Journal of Allergy and Clinical Immunology

394

380

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“…A single sting from these insects in a sensitized individual may result in an anaphylactic reaction and death [1]. However, in most individuals, a single sting will cause only local pain and/or a local reaction [6].…”

Section: Introductionmentioning

confidence: 99%

Multiple hymenoptera stings in children: clinical and laboratory manifestations

Broides

Maimon

Landau³

et al. 2010

Eur J Pediatr

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Multiple hymenoptera stings are a cause of rhabdomyolysis, elevated liver enzymes, clotting abnormalities, kidney injury, and even death. However, the progression of the clinical and laboratory findings has been described mainly in sporadic case reports. We report the clinical and laboratory manifestations of multiple hymenoptera stings in six children who were hospitalized and referred for a nephrology evaluation and follow-up over a 12-year period. One patient succumbed 13 h after the stinging accident. In the five surviving patients, we found somewhat similar pattern of clinical and laboratory course: rhabdomyolysis with elevated liver enzymes are the earliest manifestations, followed by kidney injury and anemia. An asymptomatic phase of several days between the stinging accident and severe kidney injury can occur. There was a strong seasonal association, with all six events occurring in August or September. In children with multiple hymenoptera stings, a somewhat predictable clinical and laboratory course is expected and an initial laboratory evaluation is needed, and even in asymptomatic children, a repeated laboratory evaluation is highly recommended.

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“…47,48 Moreover, it is not recommended in patients with extensive local reactions either, although in the United States, a pilot study on selected cases of desensitization of patients with this type of a reaction was published. 49 Other current contraindications to VIT according to the 2015 EAA-CI guidelines are more flexible nowadays than in the past (TABLE 5). 50 There are 2 steps of the VIT procedure: the initial (up-dosing) phase of immunotherapy with aqueous venom extracts and the maintenance phase with aqueous or depot venom extract.…”

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confidence: 99%

Insect sting allergy in adults: key messages for clinicians

Nittner-Marszalska¹,

Cichocka‐Jarosz²

2015

Polish Archives of Internal Medicine

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In most affected persons, a Hymenoptera sting results in local itching and mild induration. There are some individuals, however, who additionally respond to a sting by developing sensitization manifested by the presence of venom-specific immunoglobulin E (IgE) antibodies (vsIgE) to various components of insect venoms (in honeybee venom, 12 allergens have been identified so far: Api m1 -Api m 12; in wasp venom, 5 allergens have been identified: Vesp v 1, V v 2, Vesp v 3, Vesp v5, and Ves v 6). 2 Venom sensitization is the key factor for but is not synonymous with venom allergy. Sensitization to Hymenoptera venoms may be asymptomatic (hypersensitivity not clinically relevant) or symptomatic defined as Hymenoptera--venom allergy (HVA). The asymptomatic sensitization is common and found in 9.3% to 40.7% of the general population and in 30% to 60% of beekeepers (which reflects the effect of exposition toThe occurrence of Hymenoptera-venom allergy Allergic reactions to insect bites result most frequently from stings of flying insects of the Hymenoptera order. From among over 100 000 species of Hymenoptera, the ones mainly responsible for sting reactions are usually honeybee (Apis mellifera) as well as wasps and hornets (eg, Vespula germanica, V. vulgaris, V. rufa, Vespae sp.). However, potential perpetrators of Hymenoptera allegry are diverse and vary with geography. In southern Europe, there are paper wasps (Polistinae subfamilies); in the United States, there are fire ants (Solenopsis invicta); and in Australia, there are Jack jumper ants (Myrmecia pilosula) that seem to cause more problems. A large number of Hymenoptera species, their ways of feeding, and their aggressive defense behavior result in as many as 56.6% to 94.5% of people experiencing at least 1 sting in their lives. ABSTRACTDuring their lifetime, 94.5% of people are stung by wasps, honeybees, hornets, or bumble-bees (order Hymenoptera). After a sting, most people show typical local symptoms, 5% to 15% develop local allergic reactions, and 3% to 8.9%-systemic allergic reactions (SARs), which may be potentially life-threatening in about 10% of them. In mild forms of Hymenoptera-venom allergy (HVA), the leading symptoms are urticaria and edema (grades I and II, respectively, according to the Mueller classification). Severe SARs are classified as grade III (respiratory symptoms) and IV (cardiovascular symptoms). Rare manifestations of HVA are Kounis syndrome and takotsubo cardiomyopathy. All patients after an SAR require standard (skin test, IgE, tryptase) or comprehensive (component diagnosis, basophil activation test) allergy testing. All patients with severe systemic symptoms (hypertension, disturbances in consciousness) should be tested for mastocytosis. Additionally, a relationship was found between the severity of HVA symptoms and intake of angiotensin-converting enzyme inhibitors (ACEIs). There is a similar concern, although less well-documented, about the use of β-blockers. Patients with HVA who have experienced a SAR are potential candidates for ...

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Venom immunotherapy reduces large local reactions to insect stings

Cited by 90 publications

References 24 publications

Anaphylaxis

Anaphylaxis

Multiple hymenoptera stings in children: clinical and laboratory manifestations

Insect sting allergy in adults: key messages for clinicians

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