Hymenoptera Venom Anaphylaxis Research Articles

Evidence-based data support strategies for the prevention of Hymenoptera venom anaphylaxis.

This review aims to identify phenotypes at-risk of Hymenoptera venom-induced anaphylaxis (HVA), focusing on different perspectives (epidemiological, clinical, and therapeutic) in order to adapt future preventive strategies. HVA remains one of the leading causes of anaphylaxis, with a broad pattern of symptoms. Although most cases occur outside healthcare settings, data indicate a high emergency admission rate due to insect stings. Mortality is often underestimated because of the lack of witnesses and difficulties in recognizing the signs and the culprit. Targeting risk factors could be a clue to improve these statistics and the prognosis of the disease.Potential risk factors for severe HVA in the European population are basal serum tryptase (BST) above 8 μg, mast cell disorders, the absence of skin symptoms, and cardiovascular conditions requiring the use of beta blockers and ACE inhibitors. Identifying these criteria, mainly based on clinical patterns, helps to develop personalized strategies for management and prevention. With a personalized medicine approach, phenotypes must be characterized to adapt to the management of patients suffering from Hymenoptera venom anaphylaxis (HVA), including venom immunotherapy (VIT). In this systematic review, all articles mentioned systemic reactions with heterogeneous severity degrees. Half of those reported grade III-IV systemic reactions (Ring and Messmer). HVA clinical patterns could be worsened by one Hymenoptera sting, a patient's history with mast cell disorders, or cardiovascular diseases. VIT failure was attributed to bee venom extract and monotherapy in two-thirds of publications. Findings stress the difficulty of having uniform epidemiological data on HVA and the lack of financial support in some world regions to support appropriate management of these conditions. Although observing a heterogeneity of data, we were able to identify potential risk factors, in particular for the severe cases. We believe our work will support allergists and health professionals to implement improved personalized management of patients suffering from severe HVA.

The paradigm shift in allergy consultations through a digital ecosystem.

In Spain, specialist outpatient care traditionally relied on in-person consultations at public hospitals, leading to long wait times and limited clinical analysis in appointment assignments. However, the emergence of Information and Communication Technologies (ICTs) has transformed patient care, creating a seamless healthcare ecosystem. At the Allergy Department, we aimed to share our experience in transitioning form a traditional linear model of patient flow across different healthcare levels to the implementation of a digital ecosystem. By telemedicine, we can prioritize individuals based on clinical relevance, promptly and efficiently addressing potentially life-threatening conditions such as severe uncontrolled asthma or hymenoptera venom anaphylaxis. Furthermore, our adoption of telephone consultations has markedly reduced the need for in-person hospital visits, while issues with unstable patients are swiftly addressed via WhatsApp. This innovative approach not only enhances efficiency but also facilitates the dissemination of personalized medical information through various channels, contributing to public awareness and education, particularly regarding allergies. Concerns related to confidentiality, data privacy, and the necessity for informed consent must thoroughly be addressed. Also, to ensure the success of ICT integration, it is imperative to focus on the quality of educational information, its efficient dissemination, and anticipate potential unforeseen consequences. Sharing experiences across diverse health frameworks and medical specialties becomes crucial in refining these processes, drawing insights from the collective experiences of others. This collaborative effort aims to contribute to the ongoing development of a more effective and sustainable healthcare system.

Immunothérapie allergénique aux venins d’hyménoptères : stop ou encore ?

Hymenoptera venom immunotherapy (VIT) is the only curative treatment for preventing effectively severe insect sting anaphylaxis. The overall cumulative risk of relapse at 10 years after discontinuing VIT is estimated at 17 %, but is mainly dependent on associated risk factors. The decision to discontinue or continue VIT depends on the patient's individual risk profile which takes into account the elements related to the initial sting reaction (severity, stinging insect), the characteristics of the patient himself (exposure, age, medical problems or treatments), the tolerance and efficacy of VIT and the presence or absence of certain biomarkers. Maintenance of an ongoing VIT is possible in case of treated severe cardio-respiratory diseases, stabilized systemic autoimmune diseases and tumors or in remission, primary or acquired immune deficits and immunomodulatory or immunosuppressive treatments. Lifelong VIT is indicated in case of clonal mast cell disorder or systemic mastocytosis, for any patient having experienced very severe or near-fatal hymenoptera venom anaphylaxis, and possibly also in case of hereditary alpha-tryptasemia, with the aim of protecting the patient from a severe, potentially fatal anaphylactic relapse.

Health disparities in hymenoptera venom allergy management.

Background: Hymenoptera venom anaphylaxis (HVA) is reported in up to 3% of stings and accounts for approximately 40 US deaths annually. HVA patients require immediate availability of epinephrine and Allergist referrals for consideration of venom immunotherapy. Data regarding epinephrine autoinjector prescriptions, Allergist referral rates, and potential racial disparities are limited. Objective: The primary objective was to determine if there were statistically significant differences in epinephrine autoinjector prescriptions and Allergist referrals between white and African American patients. The secondary objectives were to determine if there were statistically significant differences between adult and pediatric patients and to determine if there were significant differences between epinephrine prescriptions between patients with and without Allergist referrals. Method: This study is a retrospective, descriptive chart review analyzing patients seen between January 01, 2019 and December 31, 2021. Data were obtained utilizing the Epic Systems (Verona, WI) application Slicer Dicer. Individual chart review was performed for age, race, epinephrine autoinjector prescription, and Allergist referral. Results: 342 patients were identified as having HVA. White patients (60 out of 219; 27.4%) were more likely to get epinephrine autoinjector prescriptions than African American patients (17 out of 109; 15.6%) (p = 0.018). Adult patients (25 out of 314; 8.0%) were less likely than pediatric patients (8 out of 28; 28.6%) to have Allergist referrals (p = 0.004). Patients with Allergist referrals (25 out of 32; 78.1%) were more likely to be prescribed an epinephrine autoinjector than patient without Allergist referrals (54 out of 310; 17.4%) (p < 0.00001). Conclusion: Epinephrine autoinjector prescriptions and Allergist referrals are low overall in HVA. Racial disparities were identified with African American patients being significantly less likely to receive epinephrine autoinjector prescriptions. Additionally, adult patients, who may be at increased risk, were less likely to receive Allergist referrals.

Health-related quality of life in severe hypersensitivity reactions: focus on severe allergic asthma and hymenoptera venom anaphylaxis-a cross-sectional study.

Growing evidence reveals the important role of clinical psychological factors in chronic-immune diseases. The aim of this study was to investigate Health-Related Quality of Life (HR-QoL), depression, anxiety, and alexithymia in patients with severe hypersensitivity reactions such as Severe Allergic Asthma (SAA) and Hymenoptera Venom Anaphylaxis (HVA). The Short-Form Health Survey-36 (SF-36), the Beck Depression Inventory Questionnaire (BDI-II), the Hamilton Anxiety Rating Scale (HAM-A) and the Toronto Alexithymia Scale (TAS-20) were used to assess HR-QoL and clinical psychological features of patients with SAA and HVA. Overall, 78 patients were recruited. Patients with SAA (n = 35) reported lower scores for physical functioning [65 (58-75) vs. 90 (85-95); p = <0.001], role limitations due to physical health [25 (0-50) vs. 62 (50-75); p = 0.004], bodily pain [47.5 (41.1-61.3) vs. 55.5 (55-96); p = 0.001], general health [40 (30-60) vs. 70 (50-80); p = 0.0003] and social functioning [50 (37.5-62.5) vs. 62.5 (54.9-75); p = 0.007] while higher scores for depressive symptoms [14 (11-15.4) vs. (9.5 (6-15.4); p = 0.05)] compared to HVA patients (n = 43). All the dimensions of SF-36 were negatively correlated with anxiety (r from -0.26 to -0.66; p all < 0.01) and depressive symptoms (r from -0.44 to -0.73; p all < 0.001). Alexithymia was negatively correlated with vitality (r = -0.28; p = 0.02) and mental health (r = -027; p = 0.03). Additionally, patients with alexithymia (38% of participants) showed higher levels of depressive symptoms [9.5 (10-19) vs. 14 (6-13.9); p = 0.005] and anxiety levels [31 (27.9-35) vs. 24 (16-33.9); p = 0.02]; they also showed less vitality [40 (39.9-50) vs. 55 (50-60) p = 0.01], social functioning [50 (37.5-62.5) vs. 62.5 (50 vs. 75); p = 0.01] and mental health [48 (44-60) vs. 68 (56-76); p = 0.004]. Clinical psychological features due to severe hypersensitive reactions may contribute to the patient's perceived HR-QoL. Focused clinical psychological interventions should be promoted to improve the clinical management of such conditions.

Healthcare Disparities In Hymenoptera Venom Allergy Management

Hymenoptera venom anaphylaxis (HVA) is reported in 0.3-3% of stings and accounts for approximately 40 US deaths annually. HVA patients require immediate availability of epinephrine and Allergist referrals for consideration of venom immunotherapy. Data regarding epinephrine autoinjector prescriptions, Allergist referral rates, and potential racial disparities are limited.

Allergie au venin d’hyménoptère, désordres mastocytaires clonaux et alpha-tryptasémie héréditaire

Severe hymenoptera venom anaphylaxis (HVA) is specifically associated with clonal mast cell disorder (CMD) and hereditary alpha-tryptasémia (HαT). About 8% of hymenoptera venom allergic patients present a CMD. HαT is found in at least 8.5% of patients with Müller grade 4 HVA. For these patients the risk for fatal anaphylaxis is highest. The coexistence of HαT with CMD increases the risk of severe or fatal HVA.The atypical presentation of allergic reactions in case of CMD or HαT might lead to inappropriate care and management if proper diagnosis is missed, underscoring the importance and need for diagnostic strategies in order to correctly identify these patients. Predominant cardiovascular symptoms in the absence of urticaria or angioedema after an insect sting are suggestive of underlying CMD, and should be distinguished from panic attack or vasovagal syncope. Similarly, an unexplained syncope or an “idiopathic” anaphylaxis might reveal mastocytosis or HαT.Venom immunotherapy (VIT) is essential for all patients with CMD or with elevated basal tryptase levels and should be maintained life-long because of the high risk of severe or sometimes fatal relapse when VIT is discontinued.

JESSNER LYMPHOCYTIC INFILTRATE POST COVID VACCINATION

Jessner-Kanof lymphocytic inltrate is a rare benign chronic T cell inltrative disease characterized by multiple tumid erythematous papules,plaques and nodules predominantly on sun exposed sites like face, neck and upper back. Etiology of Jessner lymphocytic inltrate is unknown but autoimmunity, Borrelia burgdorferi infection may have a possible role. There is a case report of Jessner lymphocytic inltrate after third dose of bee venom immunotherapy in hymenoptera venom anaphylaxis. Here,we report a case of 27 year married female who presented with multiple erythematous plaques and few nodules on face ,neck and upper back after 2 days of second dose of covishield vaccine. Clinical and histopathological correlation conrmed the diagnosis of Jessner-Kanof lymphocytic inltrate. Skin biopsy revealed dense perivascular and periadnexal lymphocytic inltrates in the dermis. Dermatological manifestations with covid vaccines are few in clinical volunteers but have been increasing since mass vaccination has started. A few side effects like urticaria , erythema and edema at injection site, pityriasis rosea, covid toes, systemic lupus erythematosus,rheumatoid arthritis have been reported after covid vaccination.

Fatal hymenoptera venom anaphylaxis by undetected clonal mast cell disorder: A better identification of high risk patients is needed

Hymenoptera venom anaphylaxis is the most frequent cause of anaphylaxis and responsible for about 20% of all fatal anaphylaxis cases in adults. We report two cases of fatal hymenoptera venom anaphylaxis with undiagnosed underlying mastocytosis and review the risk factors for severe or fatal hymenoptera venom anaphylaxis, as well as the specificities of its association with mastocytosis. As hymenoptera venom allergic patients with underlying clonal mast cell disorder generally lack typical skin lesions of mastocytosis, its diagnosis can easily be missed, underscoring the importance and need for diagnostic strategies in order to correctly identify these patients. Predominant cardiovascular symptoms in the absence of urticaria or angioedema following an insect sting are suggestive of underlying clonal mast cell disorder, and should be distinguished from panic attack or vasovagal syncope. Similarly, an unexplained syncope or an “idiopathic” anaphylaxis might reveal mastocytosis or hereditary alpha-tryptasemia. Acute and basal serum tryptase measurements should always be integrated in the diagnostic work-up of an insect sting reaction or unexplained syncope or shock of any origin.

Unsatisfactory agreement using current classification of maculopapular cutaneous mastocytosis.

Mastocytosis is a disease characterized by abnormal accumulation and expansion of tissue mast cells in the skin, bone marrow or other organs.1 Cutaneous (CM) and systemic forms (SM) of mastocytosis have been distinguished.1 CM is usually diagnosed in childhood and has a good prognosis with regression of skin lesions during puberty. Recently, many adults with mastocytosis are identified because of hymenoptera venom anaphylaxis together with increased baseline serum tryptase levels, even without skin lesions. However, in most adults, mastocytosis is still diagnosed because of their cutaneous manifestations.2 The 2001 WHO classification divided CM into maculopapular CM (urticaria pigmentosa, UP, MPCM), the most common form in children and adults, diffuse cutaneous mastocytosis (DCM) and solitary mastocytoma in childhood-onset mastocytosis, which is still valid. Skin lesions differ between children and adults with mastocytosis3 and may have some value in making a prognosis for disease progression or regression2: although the extent and maximum density of MPCM skin lesions are comparable between children and adults, children have a significantly higher diameter of lesions, a different predominant distribution more often involving the head and show a more variable clinical picture.3 Based on dermatological morphological criteria, a plaque and a nodular form have been delineated in children and a telangiectatic subvariant (also referred to as telangiectasia macularis eruptiva perstans, TMEP) in adults.4 The existence of the latter as singular entity has meanwhile been questioned by our expert group, but has brought attention to the existence of more erythematous less pigmented lesions in adult MPCM. In 2016, a prognostic simplistic consensus subclassification for MPCM has been proposed defining two variants: (i) a monomorphic variant, typically seen in adult patients, presenting with macules or papules of 3–5 mm diameter or (ii) a polymorphic variant with larger lesions of variable size, colour and shape, often asymmetric and typically seen in children.5 The hypothesis, backed up by initial evidence, is that monomorphic lesions in children indicate the presence of systemic disease and persistence of mastocytosis into adulthood, whereas polymorphic lesions might correspond to a good prognosis. The study by Torrelo et al.6 in this issue of the Journal describes their experience with the validation of this classification. They presented pictures of 19 sample cases with childhood mastocytosis to 10 European or US experts experienced with mastocytosis and asked them to classify these cases. Pictures were also displayed to 129 general dermatologists after explaining, reading and discussing the relevant text in the consensus report for 15 min and showing the examples presented in it. The value of kappa interobserver variability coefficient for the 10 experts was ‘fair’ and for the group of 129 dermatologists ‘slight’. This has been considered inadequate because of missing agreement among experts and dermatologists far below expectations for a satisfactory classification system. This is highly disturbing as unambiguity is needed for a good classification. The outcome signals a need for readjustment or for a different classification system. The definition of polymorphic and monomorphic variants has been insufficiently explained, is mostly intuitive and may be misleading. Clear instructions on how (i) shape, (ii) colour and (iii) size should be measured objectively and exactly which criteria clearly distinguish polymorphic from monomorphic are lacking. For dermatologists, this terminology may be confusing. ‘Polymorphism’ describes the occurrence of two or more clearly different morphs or forms. The diagnosis ‘polymorphic light dermatosis’ depicts that the same disease may show different morphological patterns in different patients. The term ‘polymorphic lesions’ describes lesions of different shapes and sizes in one given patient. However, the degree of difference needed to call lesions ‘polymorphic’ remains undefined, as reflected by the results of the study.6 We dermatologists make our diagnoses based on morphology and on our nomenclature of patterns and features. Thus, we specify distribution and lesion morphology, such as macules, papules, plaques, nodules or tumours, often with objective parameters such as sizes, colours and shapes to describe a patient precisely. Although using monomorphism versus polymorphism of shape, colour and/or size in the same patient may be a key for MPCM classification, it may not present the best possible system, as it does not follow the dermatologist's way of thinking and leads to disagreement among observers. For dermatologists, it would come much more natural to use the commonly used terminology defining subcategories of macular, papular, nodular or plaque forms for describing the phenotype of a given patient. One simple possibility for a two-category approach might be by size alone, for example small-sized individual lesions ≤6 mm also allowing confluence to larger patches versus individual lesions >6 mm, which at least would be measurable, understandable and lead to a better agreement among observers. The author declares no conflicts of interest. No external sources of funding.

Prevalence of mastocytosis and Hymenoptera venom allergy in the United States

Mastocytosis is a risk factor for Hymenoptera venom anaphylaxis (HVA). Current guidelines recommend measuring tryptase in patients with HVA and that those with mastocytosis pursue lifelong venom immunotherapy (VIT). Available data on HVA and mastocytosis largely derive from European single-center studies, and the prevalence of HVA with and without mastocytosis in the United States is unknown. We sought to determine the prevalence of HVA and mastocytosis in the United States using an insurance claims database and evaluate the impact of mastocytosis on VIT in patients with HVA in a US cohort. The IBM Watson Database, consisting of insurance claims from approximately 27 million US patients in 2018, was queried to identify patients with HVA and/or mastocytosis. Furthermore, a retrospective study of 161 patients undergoing VIT between 2015 and 2018 at the University of Michigan was conducted. In the IBM Watson Database, the prevalence of HVA was 167 per 100,000 (0.167%) and the prevalence of mastocytosis 10 per 100,000 (0.010%) overall and 97 per 100,000 (0.097%) among those with HVA. Mastocytosis showed a 9.7-fold increase among patients with HVA versus the general population. In the U-M cohort, 2.6% of patients with VIT had mastocytosis. Tryptase level did not correlate with venom reaction severity but was higher in patients with systemic VIT reactions. We observed a lower US HVA prevalence than previously reported. Mastocytosis was more common in US patients with HVA, though at lower rates than previously reported. In patients with VIT there was no correlation between tryptase level and reaction severity.

Aberrant mature active mast cells in wasp venom anaphylaxis associated with clonal mast cell disorders

Uncertainties remain about the molecular mechanisms that lead to Hymenoptera venom anaphylaxis (HVA), especially in patients with an underlying clonal mast cell disorder (CMCD) who show a different clinical presentation than patients without CMCD. This study aims to compare the burden, phenotypical and behavioural profiles of mast cells (MC) and basophils in patients with wasp venom anaphylaxis with CMCD (WVA/CMCD) vs. wasp venom anaphylaxis without CMCD (WVA).

Venom immunotherapy in patients with mastocytosis

Background: A clear relationship has been demonstrated between hymenoptera venom anaphylaxis (HVA) and primary mast cell activation syndromes (MCAS). Methods: This review describes the clinical and biological characteristics of patients with primary MCAS who present with HVA, the diagnostic tests that have demonstrated to be useful, and the safety and effectiveness of venom immunotherapy (VIT) in these individuals. Results: Patients presenting with dizziness or hypotension and without skin involvement after an insect sting are at an increased risk of presenting clonal mast cells (MCs). They usually have low MC burden and highly sensitive techniques are mandatory to reach a final assessment. Skin testing and determinations of specific IgE are useful in detecting patients who are candidates for VIT, which has proved to be safe and effective. Conclusions: Patients with primary MCAS and IgE-mediated HVA are candidates to receive VIT. Their management does not differ much from general population with the exception of VIT duration.

One-day ultrarush desensitization for Hymenoptera venom anaphylaxis in patients with and without mast cell disorders with adjuvant omalizumab

Systemic hypersensitivity reactions to Hymenoptera venom occur in 1.2% to 3.5% of the population. In patients with systemic mastocytosis, the incidence of Hymenoptera-induced systemic reactions is 20% to 50%, considerably greater than that in the general population.1 Fatalities are rare but have been reported in patients with and without mastocytosis.

Mastocytosis presenting as insect anaphylaxis: gender differences and natural history.

Currently, there is strong evidence about an association between hymenoptera venom anaphylaxis (HVA) and mastocytosis. This review is focused on the most relevant clinical and biological features of systemic mastocytosis associated with HVA. HVA is a relatively common complication that modifies the natural course of patients with mastocytosis, particularly men with indolent systemic mastocytosis without skin lesions (ISMs-) in whom HVA can be the presenting symptom in up to around one-half of the cases. Patients with ISMs- associated with HVA are typically males with cardiovascular symptoms in the absence of itching, urticaria, and angioedema during anaphylaxis. Noteworthy, ISMs- is characterized by a low bone marrow mast cell load and a low risk for disease progression. Early and more recent studies support that specific venom immunotherapy (VIT) is a well-tolerated and effective treatment in patients with mastocytosis. VIT should be given life-long to all patients with mastocytosis and proven immunoglobulin E (IgE)-mediated HVA. In patients with negative venom skin test and undetectable IgE antibodies, additional studies such as component-based allergy testing might contribute to confirm an IgE-mediated mechanism of anaphylaxis in some cases, thus providing the indication of VIT.

Venom immunotherapy in patients with clonal mast cell disorders: IgG4 correlates with protection.

Patients with clonal mast cell disorders (cMCD), systemic mastocytosis (SM) and monoclonal mast cell activation syndrome (MMAS), represent an increased risk for Hymenoptera venom anaphylaxis (HVA). Lifelong venom immunotherapy (VIT) is recommended; however, its efficacy and safety are controversial. Hence, we sought to evaluate the efficacy and safety of VIT in HVA patients with cMCD. A retrospective study was conducted among 46 patients with Vespula venom allergy who had experienced severe HVA, 32 cMCD (22 with SM and 10 with MMAS) and 14 controls. There were no differences between cMCD patients and controls in age (58 vs 66) and duration of VIT (47 vs 48months), respectively. During VIT, 11 (34%) cMCD patients experienced adverse reactions (ARs) (7% in controls), including 1 anaphylaxis. There were 23 re-stings in 17 (53%) patients during VIT. Of episodes, four (17%) presented with anaphylaxis, 14 (60%) presented with local reaction, and five (23%) were asymptomatic. In 11 episodes (48%), the patient did not take epinephrine, of these 8 (73%) presented with local reaction, and 3 (27%) were asymptomatic. Patient-based protection from anaphylaxis was 76% (4/17) in cMCD vs. 100% in controls during VIT. The venom-specific IgG4 concentrations increased during VIT (P<.001) although tryptase and IgE were unaltered. Both safety and efficacy of VIT in cMCD patients were slightly reduced than controls. Severe ARs were rare. The elevated IgG4 levels may be a biomarker for efficacy of VIT in cMCD patients, as it correlates with protection from re-stings.

Importance of wasp and honey bee recombinant allergens in the diagnosis of hymenoptera venom anaphylaxis

Background: Hymenoptera venom-allergic patients frequently present multiple sensitisations. Objectives: To define the allergic profile by components in Hymenoptera venom allergic patients. To study the usefulness of specific IgE to components in cases of negative results of sIgE to the venoms. Patients (n = 86) with a diagnosis of allergic systemic reaction following honey bee or wasp stings were included in the study. Skin prick tests (SPT) and intradermal reaction were performed. sIgE to complete extracts of honey bee (Apis mellifera), Vespula (Vespula spp.), venom and recombinant allergens rApi m1, rApi m 5; rVes v5 and rVes v1 5 were analysed by ImmunoCAP (Phadia). sIgE concentration higher than 0.35 kU/l were considered positive. Results: 86 patients (40 male, 46 female) were included. No sIgE to Honey bee/Vespula was detected in 15 patients. In 7 of them only component diagnosis (Api m1 and Ves v5) confirmed hymenoptera allergy. Positive correlation between severity of anaphylactic reaction and sIgE to rVes v1 concentration was observed (r = 0,85; p < 0.05) and sIgE to rApi m1 (r = 0.87; p < 0.05). None such correlation was observed with specific IgE to other venom components. Conclusions: Components analysis can be useful to make diagnosis more accurate. Determination of sIgE towards phospholipase A2 (Apis mellifera) and phospholipase A1 (Vespula spp.) may reflects severity of allergic reaction after hymenoptera sting.

Imported fire ant hypersensitivity and mastocytosis: A case series of successful venom immunotherapy

The prevalence of flying Hymenoptera venom hypersensitivity in patients with mast cell activation disorders (MCADs) is approximately 25% vs 2% in the general population. 1 Niedoszytko M. Bonadonna P. Oude-Elberink J.N.G. Golden D.B.K. Epidemiology, diagnosis, and treatment of Hymenoptera venom in allergy in mastocytosis patients. Immunol Allergy Clin North Am. 2014; 34: 365-381 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar Previous studies have reported success with venom immunotherapy (VIT) for flying Hymenoptera hypersensitivity in the setting of MCADa. 2 Gonzalez de Olano D. Alvarez-Twose I. Esteban-Lopez M. et al. Safety and effectiveness of immunotherapy in patients with indolent systemic mastocytosis presenting with Hymenoptera venom anaphylaxis. J Allergy Clin Immunol. 2008; 121: 519-526 Abstract Full Text Full Text PDF PubMed Scopus (109) Google Scholar To date, there are no cases of hypersensitivity to the imported fire ant (IFA), Solenopsis invicta/Solenopsis richteri specifically, in patients with MCADa in the literature. Moreover, this case series is the first, to our knowledge, to describe patients with MCADs and documented IFA hypersensitivity who have successfully completed the build-up phase of IFA–whole body extract (WBE) immunotherapy using conventional and rush protocols.

Venom allergy treatment practices in Poland in comparison to guidelines: next edition of the national audit.

IntroductionVenom immunotherapy treatment (VIT) is the only causal treatment of hymenoptera venom anaphylaxis, which aims to provide long-lasting immunoprotection against severe reactions to subsequent stings.AimTo reassess the compliance of VIT procedures in the Polish allergy centres with the European guidelines.Material and methodsA structured questionnaire survey conducted in all 33 VIT-centres. The response rate was 94%.ResultsThe ultrarush initial protocol was the most common protocol (71%, n = 22), usually lasting for 3.5 h (50%, n = 7). The most frequent (36%, n = 11) time interval from the initial to the first maintenance dose (MD) was 14 days, ranging from 7 to 35 days. All centres used an MD of 100 μg. The most frequent time interval between subsequent MDs was 4 weeks (58%, n = 18). Five years’ of VIT was declared by 71% (n = 22). Before the termination of treatment, more than half of the centres (58%, n = 18) performed sIgE and almost half (42%, n = 13) performed skin tests. To confirm VIT efficacy, few centres (26%, n = 8) conducted the sting challenge. About half of centres provided the patients with an adrenalin auto-injector both at the time of initial diagnostics and at the end of treatment. More than half (55%, n = 17) used antihistamines in all patients. Almost half (45%, n = 14) declared to stop treatment with β-blockers and almost one fourth (23%, n = 7) discontinued angiotensin-converting-enzyme inhibitors.ConclusionsIn the most important procedures, there is a very high compliance with the guidelines. In the areas where the guidelines are not precise, we observed a large spread of results.

Prevalence of Clonal Mast Cell Disorders in Patients Presenting With Hymenoptera Venom Anaphylaxis Might Be Higher Than Expected.

Prevalence of Clonal Mast Cell Disorders in Patients Presenting With Hymenoptera Venom Anaphylaxis Might Be Higher Than Expected.