Risk factors and indicators of severe systemic insect sting reactions.
Hymenoptera venom allergy ranks among the top three causes of anaphylaxis worldwide, and approximately one-quarter of sting-induced reactions are classified as severe. Fatal sting reactions are exceedingly rare, but certain factors may entail a considerably higher risk. Delayed administration of epinephrine and upright posture are situational risk factors which may determine an unfavorable outcome of the acute anaphylactic episode and should be addressed during individual patient education. Systemic mastocytosis and senior age are major, unmodifiable long-term risk factors and thus reinforce the indication for venom immunotherapy. Vespid venom allergy and male sex likewise augment the risk of severe or even fatal reactions. Further studies are required to assess the impact of specific cardiovascular comorbidities. Available data regarding potential effects of beta-blockers and/or ACE inhibitors in coexisting venom allergy are inconclusive and do not justify recommendations to discontinue guideline-directed antihypertensive treatment. The absence of urticaria/angioedema during sting-induced anaphylaxis is indicative of a severe reaction, serum tryptase elevation, and mast cell clonality. Determination of basal serum tryptase levels is an established diagnostic tool for risk assessment in Hymenoptera venom-allergic patients. Measurement of platelet-activating factor acetylhydrolase activity represents a complementary approach but is not available for routine diagnostic use.
['Stoevesandt|Johanna|J|0000-0001-6681-3192', 'Sturm|Gunter J|GJ|0000-0002-7245-121X', 'Bonadonna|Patrizia|P|', 'Oude Elberink|Joanna N G|JNG|', 'Trautmann|Axel|A|']
D000707:Anaphylaxis D000818:Animals D001180:Arthropod Venoms D006801:Humans D006927:Hymenoptera D007299:Insect Bites and Stings D008297:Male D012307:Risk Factors
venom mastocytosis age tryptase medication