Risk Factors For Systemic Reactions Research Articles

Risk factors for systemic reactions to bee venom in British beekeepers

There is a high incidence of systemic reactions (SRs) to bee stings in beekeepers, but the factors predisposing individuals to such responses are not well understood. To identify factors that predispose British beekeepers to SRs and to investigate how beekeepers access specialist services after SRs to bee venom. A link to an online survey was published in the bimonthly magazine and on the Web site of the British Beekeepers Association. The demographic results are presented using descriptive analysis, and a logistic regression model was used to determine risk factors for SRs. There were 852 responses to the questionnaire of which 63% were from male beekeepers; the most common age range was 51 to 60 years. Twenty-eight percent of all responders had experienced a large local reaction and 21% had experienced a SR. Factors that predisposed beekeepers to SRs included female sex, having a family member with bee venom allergy, more than 2 years of beekeeping before a SR, and premedication with an antihistamine before attending the hives. A total of 44% of beekeepers with SRs attended the emergency department because of their symptoms, 16.6% were reviewed by an allergy specialist, and only 18% carried an adrenaline autoinjector. Logistic regression analysis identified a number of novel factors to be associated with the development of SRs. Rates of attendance at the emergency department, allergy specialist review, and carriage of adrenaline were low, highlighting a need for education in the beekeeping community and among health care professionals.

The local and systemic side-effects of venom and inhaled-allergen subcutaneous immunotherapy

Although immunotherapy is effective in allergic rhinitis, conjunctivitis, asthma and stinging insect hypersensitivity, it carries a risk of anaphylactic reactions. In a 4-year retrospective survey, we investigated 1257 adult patients who had received venom or inhaled-allergen subcutaneous immunotherapy. The dose-increase phase was performed as the 2-day rush protocol for venom immunotherapy and the 6-week protocol for inhaled-allergen immunotherapy. A total of 904 patients received venom immunotherapy and 353 patients inhaled-allergen immunotherapy. The prevalence of systemic reactions was 13.6%. The frequency of systemic reactions was higher during the maintenance phase than in the dose-increase phase (9.6% vs. 5.9%) and was highest in both phases of treatment with honeybee venom (P < 0.001). The majority of systemic reactions were mild. Five (0.4%) patients had reaction with a fall of blood pressure and were treated with adrenaline. There was no fatal outcome. The systemic side-effects during the dose-increase phase of venom immunotherapy occurred at a median dose of 46 microg (range 2-100 microg). Large local reactions occurred in 13.9% of patients without any significant difference between the allergens. We have shown that systemic reactions are not rare even during maintenance phase in patients with a well tolerated dose-increase phase of treatment. The most prominent risk factor for systemic reactions was immunotherapy with honeybee extract.

Bee and bee products allergy in Turkish beekeepers: determination of risk factors for systemic reactions

Background The prevalence of allergic reactions due to bee stings in beekeepers varies in different regions of the world. The aim of this study was to evaluate the characteristics of sting reactions and the risk factors for developing systemic reactions in Turkish beekeepers. Methods A self-administered questionnaire was distributed to 1250 beekeepers to be completed in seven different cities of Turkey. A total of 494 (39.6 %) questionnaires were returned. Results There were 444 subjects (89.9 %) with a history of sting exposure in the previous 12 months.Systemic reactions were present in 29 subjects (6.5 %) and nine (2 %) reactions were anaphylactic. Fifty-five percent of beekeepers reported more than 100 bee stings in the previous year. When systemic reactions were controlled by age and duration of beekeeping in a logistic regression model, seasonal rhinitis (OR: 4.4, 95 % CI: 1.2-11.5), perennial rhinitis (OR: 4.6, 95 % CI: 1.2-18.2), food allergy (OR:7.0, 95 % CI: 2.0-25.0), physician-diagnosed asthma (OR: 8.0, 95 % CI: 2.5-25.6), having an atopic disease of any type (OR: 3.3, 95 % CI: 1.2-8.7) and having two or more atopic diseases (OR: 10.9, 95 % CI: 3.5-33.8) were significantly associated with systemic reactionsdue to bee sting in the previous 12 months Conclusion The incidence of systemic reactions in Turkish beekeepers is low, which might be due to the protective effect of a high frequency of bee stings. The risk of systemic reactions increases approximately three-fold when one atopic disease is present and eleven-fold when two or more concurrent atopic diseases are present with respect to no atopic disease.

Safety of rush immunotherapy to multiple aeroallergens in an adult population

Rush immunotherapy has many potential benefits but a higher incidence of systemic reactions compared with traditional immunotherapy. The safety of rush immunotherapy to multiple aeroallergens has not been widely studied. To examine the safety of rush immunotherapy to multiple aeroallergens in a primarily adult population and to identify risk factors for systemic reactions. A retrospective review of 65 patients who received rush immunotherapy to multiple aeroallergens in a university-based allergy practice was conducted. All patients were premedicated with prednisone, cetirizine, ranitidine, and zafirlukast or montelukast. Percutaneous skin testing was performed, major allergen content was analyzed in every fourth patient's immunotherapy extract, and systemic reactions were graded. Systemic reactions were observed in 25 patients (38%). All systemic reactions occurred with the final 3 doses of the protocol. Most (72%) occurred after the final dose of the protocol. Nineteen (76%) of the reactions were mild, 5 (20%) were moderate, and 1 (4%) was severe. Systemic reactions were associated with a higher degree of skin test sensitivity and the presence of weed or dog allergen in the extract (vaccine). Rush immunotherapy is associated with a relatively high incidence of systemic reactions, but most reactions are mild and easily treated. The degree of skin sensitivity to the allergens administered and the presence of dog or weed allergen in the extract may be predictors for the development of systemic reactions.

Systemic reactions and fatalities associated with allergen immunotherapy

The primary objective of this review is to discuss systemic allergic reactions and risk factors associated with the injection of allergen vaccines. A review of the literature on anaphylactic reaction, adverse effects, and fatalities associated with allergen immunotherapy (IT) was conducted. The expert opinion of the author was used to select relevant data. Systemic allergic reactions associated with the injection of allergen vaccines usually begin within 20 minutes. However, on occasion, they begin 20 to 30 minutes or longer after an injection. Such reactions can also occur after allergen skin testing. Most reactions associated with skin testing and allergen IT are mild and readily respond to appropriate treatment. However, severe and even fatal reactions have been reported with both skin testing and IT. Risk factors for skin testing and allergen IT include: 1) patients, particularly asthmatic patients, suffering with seasonal exacerbation of their symptoms; 2) patients who demonstrate exquisite sensitivity to particular allergen(s); 3) patients on beta-blockers; 4) patients with asthma, especially if their asthma is unstable; 5) patients in whom rush IT is used; and 6) patients in whom high doses of potent standardized allergen vaccines are used. It is essential that strict attention be paid to the risk factors for systemic reactions, and that techniques and management be initiated both before and after skin testing or IT to minimize these risks. Done properly, the risk of skin testing and IT is minimal.

Bee and wasp sting reactions in current beekeepers.

A majority of subjects allergic to bee venom are beekeepers, their relatives, or neighbors. Predetermining systemic reactivity to honeybee stings and risk assessment through laboratory tests have been unsatisfactory. To estimate the prevalence and type of sting reactions, and especially to evaluate potential risk factors of systemic reactions in beekeepers. A questionnaire concerning sting reactions and potential risk factors was mailed to all members of the regional beekeepers' association; 191 beekeepers were included in the study. Systemic bee sting reactions were present in 50 (26%) and large local reactions in 73 (38%) of the beekeepers. Similar reactions following wasp stings were present in 2% and 13%, respectively. Twenty-four (48%) of the systemic reactors and 39 (28%) of the remaining subjects had a history of atopic symptoms (allergic rhinitis, allergic bronchial asthma, or atopic dermatitis). While working at hives, nasal and eye symptoms were present in 54% of the systemic reactors and in 23% of the remaining subjects. Systemic reactors were younger and had been beekeepers for a shorter period than nonreactive subjects. Multiple logistic regression analysis showed that the risk of systemic sting reaction increased fourfold when nasal or eye symptoms were present while working at hives and twofold when the years in beekeeping were less than 15. The occurrence of systemic and large local reactions after bee stings is high among beekeepers. A history of atopy is associated with systemic reactions. Both the presence of nasal or eye symptoms while working at hives and a history of beekeeping less than 15 years significantly increase the risk of systemic reactions.

Venom allergy in adult Swedes: a population study

Hymenoptera allergies are a cause of considerable morbidity. However, deaths due to insect sting constitute a health hazard that can be minimized by effective therapy. We report the results of a study of 1815 men and women, aged 20-44 years and resident in three areas of Sweden. The prevalence of sensitization to the venom allergens of honeybees and wasps was assessed by RAST. Atopy and allergic diseases were considered possible risk factors for symptom development. Of the 1815 subjects, 1399 were randomly chosen from the general population. Of the random sample, 9.3% had specific bee or wasp IgE, 1.5% reported systemic reactions to bee or wasp stings, and 0.6% had both. Sensitization to bee or wasp correlated positively with atopy (odds ratio (OR) 2.0, confidence interval (CI) 1.4-2.8, P < 0.0001), male sex (OR 1.8, CI 1.3-2.5, P < 0.001), and age (OR 2.0, CI 1.4-2.8, P < 0.01), and negatively to living in the northernmost of the three centers (OR 0.4, CI 0.3-0.7, P < 0.001). Atopy was not found to be a risk factor for systemic reactions. We conclude that the prevalence of Hymenoptera allergy in Sweden is rather low when compared with other countries. Subjects with atopy seem to have an increased risk of becoming sensitized but do not develop systemic reactions more frequently than nonatopic subjects.

The incidence and nature of adverse reactions to injection immunotherapy in bee and wasp venom allergy.

The incidence, time course and nature of systemic reactions to injections of bee and wasp venom during immunotherapy have been estimated in an open, prospective, single centre study. One hundred and nine survivors of moderate to severe systemic reactions to stings from hymenoptera, received courses of bee or wasp venom by monthly subcutaneous injection for up to 3 years. Systemic reactions were recorded after 7.5% of 946 weekly venom injections during the initial phase of treatment, and after 2.1% of 1789 monthly maintenance injections. In both phases of treatment, reactions were more frequent after bee (17% of initial phase, 7.8% of maintenance treatment) than after wasp (3% of initial phase, 0.3% of maintenance treatment) venom injections. The percentage of patients experiencing at least one reaction was also higher for bee (46%) than for wasp (14%) sensitive patients. Over 80% of reactions began within 30 min of injection, over 90% within 1 h and only two (2%), between 1 and 2 h, the remaining six (5.5%) starting more than 2 h after injection. Only 0.47% of venom injections produced a systemic reaction which was severe enough to require adrenaline treatment. The female patients experienced more reactions (21% of the wasp, 60% of the bee, sensitive) than the males (5.5% wasp, 20% bee). Age and atopy did not appear to be significant risk factors for systemic reactions. We conclude that wasp and bee venom immunotherapy in a conventional dosage regimen was generally well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunotherapy: A one-year prospective study to evaluate risk factors of systemic reactions

Background: We did a prospective study in Atlanta, Georgia, during 1991 on the rate of systemic reactions caused by immunotherapy in a clinic that uses aqueous allergen extracts. Methods: Immunotherapy reactions were monitored. Symptoms were recorded with respect to time of onset, involvement of respiratory tract or skin, and presence of hypotension. Results: There were 98 systemic reactions in 96 patients (1 per 1600 visits or 1 per 47 patients). There was no direct relationship to seasonal pollen counts. There was, however, a correlation with the August to October increase in mold counts. There was no correlation between reactions and the age of the patient or the age of the extract. Patients were more likely to experience a reaction during the buildup phase than during maintenance therapy. The time of onset and the severity of the reaction were in agreement with previous reports. Severe reactions that included hypotension all occurred less than 30 minutes after the injection. In contrast to previous reports, patients with asthma were not at higher risk for a systemic reaction. Conclusion: Immunotherapy has a significant but low rate of systemic reaction. Potentially serious reactions may be mitigated by taking extra precautions during the earlier phases of an immunotherapy program and during seasons when mold counts are high. (J A LLERGY C LIN I MMUNOL 1995;95:8-14.)

Atopy and systemic reactions to hymenoptera stings.

To evaluate whether atopy is a risk factor for systemic reactions to hymenoptera stings, we compared the atopic status of two groups of subjects. The first group included 93 patients (59 males), mean (+/- SD) age: 42.3 +/- 17.2 yrs with a history of anaphylactic reactions to hymenoptera stings. The second was a control group of 712 subjects (379 males), mean (+/- SD) age: 42.0 +/- 9.6 years recruited at a public health care center. The protocol included a standardized questionnaire about symptoms suggestive of atopy, i.e. medical diagnosis of asthma, perennial rhinitis or hay fever, and skin tests to common aeroallergens, i.e. house dust mites, cat danders, and grass pollens. The percentage of subjects with atopic symptoms was comparable in the two groups (32.2% for the patient group and 28.5% for the control group). Similarly, 22.6% of patients and 36.8% of controls exhibited at least one positive skin prick test. Lastly, 15.1% of patients and 18.5% of controls (a nonsignificant difference) had at least one symptom of atopy and at least one positive skin test. These findings show that atopy is not a risk factor for systemic reactions to hymenoptera stings.