Phenotype and risk factors of venom-induced anaphylaxis: A case-control study of the European Anaphylaxis Registry - 04/02/21
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Abstract |
Background |
Venom-induced anaphylaxis (VIA) is a common, potentially life-threatening hypersensitivity reaction associated with (1) a specific symptom profile, 2) specific cofactors, and 3) specific management. Identifying the differences in phenotypes of anaphylaxis is crucial for future management guidelines and development of a personalized medicine approach.
Objective |
This study aimed to evaluate the phenotype and risk factors of VIA.
Methods |
Using data from the European Anaphylaxis Registry (12,874 cases), we identified 3,612 patients with VIA and analyzed their cases in comparison with sex- and age-matched anaphylaxis cases triggered by other elicitors (non-VIA cases [n = 3,605]).
Results |
VIA more frequently involved more than 3 organ systems and was associated with cardiovascular symptoms. The absence of skin symptoms during anaphylaxis was correlated with baseline serum tryptase level and was associated with an increased risk of a severe reaction. Intramuscular or intravenous epinephrine was administered significantly less often in VIA, in particular, in patients without a history of anaphylaxis. A baseline serum tryptase level within the upper normal range (8-11.5 ng/mL) was more frequently associated with severe anaphylaxis.
Conclusion |
Using a large cohort of VIA cases, we have validated that patients with intermediate baseline serum tryptase levels (8-11 ng/mL) and without skin involvement have a higher risk of severe VIA. Patients receiving β-blockers or angiotensin-converting enzyme inhibitors had a higher risk of developing severe cardiovascular symptoms (including cardiac arrest) in VIA and non-VIA cases. Patients experiencing VIA received epinephrine less frequently than did cases with non-VIA.
Il testo completo di questo articolo è disponibile in PDF.Key words : Anaphylaxis, epinephrine (adrenaline), β-blockers, insect venom allergy, Hymenoptera
Abbreviations used : ACEI, BST, ER, SIT, VIA
Mappa
Disclosure of potential conflict of interest: A. Bauer reports personal fees from ALK, Allergopharma, Allergy Therapeutics, Diater, LETI, Thermo Fisher, and Stallergens outside the submitted work. N. Wagner reports personal fees from ALK outside the submitted work. R. Treudler reports grants and personal fees from Sanofi-Genzyme, ALK-Abelló, Takeda, and Novartis and grants from Hautnetz Leipzig and Fraunhofer-IZI Leipzig outside the submitted work. V. Cardona reports personal fees from ALK, Allergopharma, Allergy Therapeutics, Diater, LET, Thermo Fisher, and Stallergens outside the submitted work. M. B. Bilò reports personal fees from ALK outside the submitted work. K. Scherer reports personal fees from Allergopharma, Sanofi-Aventis, and Shire outside submitted work. Franziska Ruëff reports personal fees outside the submitted work from ALK-Abelló, Allergopharma, Bencard, Boehringer Ingelheim, Bristol-Myers Squibb, Circassia, Dermira, DST, LEO Pharma, Lilly, Dr Gerhard Mann Chem-Pharm Fabrik GmbH, Mylan, Novartis, Pfizer, Thermo Fisher Scientific, and UCB. C. Pföhler has performed clinical studies for Allergy Therapeutics and has received speaker honoraria and travel support from Bencard, Novartis, and ALK. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 147 - N° 2
P. 653 - Febbraio 2021 Ritorno al numeroBenvenuto su EM|consulte, il riferimento dei professionisti della salute.
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