Predictors of severe anaphylaxis in Hymenoptera venom allergy

Severe anaphylaxis to honeybee or vespid (wasp) stings is associated with a variety of risk factors, which are poorly defined.

This study of 962 patients evaluated the association of baseline serum tryptase and other variables routinely recorded during patient evaluation with the frequency of past severe anaphylaxis after a field sting.

21.4% of patients had a severe anaphylactic reaction after a field sting.

Factors associated with severe reactions after a field sting were:

- higher tryptase concentrations
- vespid (wasp) venom allergy
- older age, male sex
- angiotensin-converting enzyme inhibitor medication

In patients with honeybee or vespid (wasp) venom allergy, baseline serum tryptase concentrations are associated with the risk for severe anaphylactic reactions. Preventive measures should include replacing angiotensin-converting enzyme inhibitors with other BP medications.


Predictors of severe systemic anaphylactic reactions in patients with Hymenoptera venom allergy: importance of baseline serum tryptase-a study of the European Academy of Allergology and Clinical Immunology Interest Group on Insect Venom Hypersensitivity. Ruëff F, Przybilla B, Biló MB, Müller U, Scheipl F, Aberer W, Birnbaum J, Bodzenta-Lukaszyk A, Bonifazi F, Bucher C, Campi P, Darsow U, Egger C, Haeberli G, Hawranek T, Körner M, Kucharewicz I, Küchenhoff H, Lang R, Quercia O, Reider N, Severino M, Sticherling M, Sturm GJ, Wüthrich B. J Allergy Clin Immunol. 2009 Nov;124(5):1047-54.
Anaphylaxis guidelines by World Allergy Organization. JACI, 2011.
Hymenoptera-Sting Hypersensitivity - NEJM review, 2014
Image source: Vespula germanica, Wikipedia, Richard Bartz, Creative Commons Attribution ShareAlike 2.5 License.

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