Hymenoptera-induced anaphylaxis: absence of urticaria/angioedema indicates severe anaphylaxis and possibly mastocytosis

Severe anaphylaxis in Hymenoptera venom allergy is associated with a number of risk factors including elevation of baseline serum tryptase (BST), older age, concomitant diseases, and concurrent medications, such as beta-blockers.

This single-center study from Germany included 650 patients fulfilling the criteria for venom immunotherapy.
4 risk factors of severe anaphylaxis were identified:

- elevation of baseline serum tryptase (BST)
- absence of urticaria or angioedema during anaphylaxis
- time interval of less than 5 minutes from sting to onset of symptoms
- senior age

Absence of urticaria/angioedema is an indicator of severe anaphylaxis and possibly mastocytosis, requiring determination of baseline serum tryptase (BST).

References:

Over- and underestimated parameters in severe Hymenoptera venom-induced anaphylaxis: Cardiovascular medication and absence of urticaria/angioedema. Stoevesandt J, Hain J, Kerstan A, Trautmann A. J Allergy Clin Immunol. 2012 May 1. [Epub ahead of print]

http://www.ncbi.nlm.nih.gov/pubmed/22554708?dopt=Abstract

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