Self-injectable Epinephrine Prescription Research Articles

Cold urticaria and your risk of anaphylaxis

Cold urticaria (CU) is characterized by the appearance of wheals or angioedema after exposure to cold. It presents with mild to severe symptoms and can even lead to anaphylaxis. The risk of systemic reactions is high. We discuss this important pathology and show its strong relationship with anaphylaxis. Cold weather is one of the most common triggers for the onset of symptoms, with variables including humidity and thermal sensation. It is divided into acquired or familial forms. The diagnosis is made in patients with a medical history suggestive of the disease and should be confirmed with a stimulation test. The central aspect of treatment is to avoid cold stimuli. The prescription of self-injectable epinephrine for groups that are at high risk of systemic reactions is ideal. In conclusion, health professionals should be aware of CU in order to recognize the risk of anaphylaxis in these patients.

Fill rates and access to self-injectable epinephrine prescribed in a pediatric emergency department.

Despite its life-saving potential in anaphylaxis, self-injectable epinephrine (SIE) is frequently not administered by caregivers prior to arrival in the emergency department (ED). Prescriptions from the ED often go unfilled which may contribute to the failure to receive SIE when needed. To determine the prescription filling rate and accessibility of SIE devices among families discharged from the Pediatric ED with an SIE prescription. A phone survey was administered to parents of children <18years of age prescribed SIE in the pediatric ED over 12months. The survey inquired if they own an SIE device, the device's expiration date as confirmation, and details of their child's allergy. Variables were analyzed for association with owning SIE, having SIE accessible when prompted, and having unexpired SIE accessible. 170 children received prescriptions for SIE and 100 (59%) completed the survey. Eighty-four of 100 (84%) had filled the initial SIE prescription. Sixty-five of 100 (65%) had proof of having SIE, of which 29% (19/65) were expired. Only 46% (46/100) of all respondents had an accessible unexpired SIE. Patients with food allergies and those who'd visited an allergist after their ED visit had higher odds of having unexpired accessible devices. A majority of patients prescribed SIE from the ED fill their prescription; however, less than half have unexpired SIE readily available despite high rates of recurrent anaphylactic emergencies. Focusing on post-discharge planning, particularly follow-up, may prevent children with allergies from being left dangerously unprepared.

Red meat allergy: clinical characteristics

Purpose: Red meat allergy has recently been described as rare food hypersensitivity with unique pathogenesis and clinical rele vance of delayed anaphylaxis. The culprits are various mammal meats containing oligosaccharide epitope (galactose-α-1,3-galactose, α-gal). Interestingly, hard tick bites precede the onset of this allergic condition. The clinical characteristics of red meat al lergy had never been reported in Korea. Methods: Among patients diagnosed with food hypersensitivity in a hospital located in Jeju, Korea, those with red meat allergy were recruited. Clinical characteristics were retrospectively reviewed and additionally interviewed. Results: Five patients (mean age, 57±4 years; 4 males and 1 female) were diagnosed as having red meat allergy. They suffered from hives, as the most common symptom, followed by shortness of breath from 10 minutes to 6 hours after exposure to the culprits. Four patients visited the emergency department for anaphylaxis. Culprits included beef, pork, dog, ham, goat, and roe deer. Chicken, duck, bacon, or horse did not cause clinical symptoms. In 4 patients, hard tick bites preceded the onset. Detection of spe cific IgE to α-gal and culprits such as beef and pork facilitated the confirmative diagnosis. They were advised to avoid mammal meats and to receive a prescription for self-injectable epinephrine. Conclusion: Red meat allergy is one of the food hypersensitivities, characterized by severe and delayed allergic reactions to various meats. Red meat allergy may be a tick-borne illness in Jeju, Korea. (Allergy Asthma Respir Dis 2020;8:142-146)

The cost-effectiveness of requiring universal vs contextual self-injectable epinephrine autoinjector for allergen immunotherapy

BackgroundAeroallergen immunotherapy (AIT) is a safe and effective disease-modifying treatment associated with rare therapy-associated fatality. Significant practice variation surrounds universal or contextual prescription of self-injectable epinephrine (SIE) for patients receiving AIT. ObjectiveTo characterize the cost-effectiveness of a universal vs contextual SIE requirement for patients receiving AIT. MethodsAn economic evaluation using cohort and microsimulation was performed from both the societal and health care sector perspectives for patients undergoing AIT, assessing a universal requirement to fill SIE prescriptions at the outset of therapy compared with requiring this only after a systemic reaction to immunotherapy (SRIT). ResultsA universal SIE requirement for AIT is not cost-effective, with the incremental cost-effectiveness ratio for this strategy estimated at $669,327,730 per quality-adjusted life-year (QALY). In the microsimulation (n = 10,000), the mean (SD) costs of a universal approach exceeded that of a more context-specific strategy where SIE was only prescribed for patients after an initial SRIT ($19,653.36 [$4296.66] vs $16,232.14 [$5204.32]), and given the effects on rates of AIT discontinuation, the universal approach was less effective (mean [SD], 25.555 [2.285] QALYs) compared with a contextualized approach (mean [SD], 25.579 [2.345] QALYs). Universal SIE prescription could be cost-effective if it provided a 1000 times protection against AIT fatality at a value-based cost of $24, and the annual AIT fatality rates unrealistically exceed 2.6 per 10,000 patients. ConclusionIn a simulation of potential SIE-prescribing strategies for patients receiving AIT, a universal approach to an epinephrine autoinjector requirement was not cost-effective when compared with an approach in which an SIE is prescribed only to patients with prior SRIT.

Barriers to self-management behaviors in college students with food allergies

ABSTRACTObjective: This study examined barriers to engagement in self-management behaviors among food-allergic college students (1) within the frameworks of the health belief model (HBM) and common sense self-regulation model (CS-SRM) and (2) in the context of overall risky behaviors. Participants: Undergraduate college students who reported having a physician-diagnosed food allergy (N = 141). Research was conducted from February 2015 through May 2016. Methods: Participants were recruited from college campuses through email and social media. The frequency of adherence to self-management behaviors was measured along with HBM, CS-SRM, and risk-taking behaviors through a self-report survey. Results: Among all participants, HBM and CS-SRM constructs and Tobacco Use explained 30.6% of the variance in adherence. CS-SRM constructs and Tobacco Use explained 44.8% of the variance for participants with self-injectable epinephrine (SIE). Conclusions: Food-allergic college students demonstrate inconsistent adherence, and interventions designed to improve adherence should take both SIE prescription status and contextual factors into consideration.

Self-injectable Epinephrine Prescription Trends in a Tertiary Referral Center

Self-injectable Epinephrine Prescription Trends in a Tertiary Referral Center

Effect of educational and electronic medical record interventions on food allergy management

The growing prevalence of food allergies indicates a responsibility among primary care providers to ensure that their patients receive accurate diagnosis and management. To improve physician knowledge and management of food allergies by implementing educational and electronic medical record interventions. Pre- and posttest scores of pediatric residents and faculty were analyzed to assess the effectiveness of an educational session designed to improve knowledge of food allergy management. One year later, a best practice advisory was implemented in the electronic medical record to alert providers to consider allergy referral whenever a diagnosis code for food allergy or epinephrine autoinjector prescription was entered. A review of charts 6 months before and 6 months after each intervention was completed to determine the impact of both interventions. Outcome measurements included referrals to an allergy clinic, prescription of self-injectable epinephrine, and documentation that written emergency action plans were provided. There was a significant increase in test scores immediately after the educational intervention (mean, 56.2 versus 84.3%; p < 0.001). Posttest scores remained significantly higher than preintervention scores 6 months later (mean score, 68.0 versus 56.2%; p = 0.006). Although knowledge improved, there was no significant difference in the percentage of patients who were provided allergy referral, were prescribed an epinephrine autoinjector, or were given an emergency action plan before and after both interventions. Neither intervention resulted in improvements in the management of children with food allergies at our pediatrics clinic. Further studies are needed to identify effective strategies to improve management of food allergies by primary care physicians.

Evaluation of Anaphylaxis Management in a Pediatric Emergency Department.

In 2006, the National Institute of Allergy and Infectious Disease established evidence-based treatment guidelines for anaphylaxis. The purpose of our study was to evaluate provider adherence to guidelines-based management for anaphylaxis in a tertiary care pediatric emergency department (ED). Retrospective chart review was conducted of patients (0-18 years) presenting to the Arkansas Children Hospital ED from 2004 to 2011 for the treatment of anaphylaxis using International Classification of Diseases, Ninth Edition, codes. Multiple characteristics including demographics, clinical features, allergen source, and anaphylaxis management were collected. Fisher exact or χ tests were used to compare proportion of patients treated with intramuscular (IM) epinephrine in the preguideline versus postguideline period. Relative risk (RR) statistics were computed to estimate the ratio of patients who received self-injectable epinephrine prescription and allergy follow-up in the preguideline and postguideline groups. A total of 187 patients (median [range] age, 7 [1-18] years; 67% male; 48% African American) were evaluated. Food (44%) and hymenoptera stings (22%) were commonly described culprit allergens, whereas 29% had no identifiable allergen. Only 47% (n = 87) received epinephrine in the ED and 31% (n = 27) via the preferred IM route. Comparing postguideline (n = 126) versus preguideline (n = 61) periods demonstrated increase in the usage of the IM route (46% postguideline vs 6% preguideline; risk ratio (RR), 7.64; 95% confidence interval [CI], 2.04-46.0; P < 0.001). Overall, 61% (n = 115) of the patients received self-injectable epinephrine upon discharge, and there were no significant differences between the groups (64% postguideline vs 56% preguideline, P = 0.30). Postguideline patients were more likely to receive a prescription compared with preguideline patients (64% postguideline vs 56% preguideline; RR, 1.15; 95% CI, 0.89-1.55; P = 0.30). Only 45% (n = 85) received an allergy referral. Postguideline patients were more likely to receive an allergy referral than preguideline patients (48% postguideline vs 41% preguideline; RR, 1.16; 95% CI, 0.81-1.73; P = 0.40). Provider use of IM epinephrine has improved since anaphylaxis guidelines were published. However, more provider education is needed to improve overall adherence of guidelines in a tertiary care pediatric ED.

A Cost-Effective Analysis of the U.S. Varicella Zoster Virus (VZV) Vaccination Program with Consideration for Delayed Onset of Asthma Following Vzv Infection

M O N D A Y 762 Long-Term Adherence to Self-Injectable Epinephrine Prescription Joyce X.W. Lee, MD, Anil M. Patel, MD, Andrew Q. Pham,MD, Sabrina T. Lee, BS, Jeffrey B. Flores, Joseph S. Yusin, MD, FAAAAI; VA Greater Los Angeles Health Care System, Los Angeles, CA. RATIONALE: Self-injectable Epinephrine (SIE) is essential for immediate treatment of anaphylaxis. Our study aims to determine long-term adherence approximately 10 years after initial SIE prescription. METHODS: A total of 173 patients who received and filled a SIE prescription between 2002 and 2003 at the VAWest Los Angeles Hospital were identified, of which 82 patients were active in the system in 2013. Patient’s gender, race/ethnicity, age, setting of initial SIE prescription, associated diagnosis, and frequency of SIE refills were collected. A prescription for SIE under the active medication list constituted adherence. RESULTS: Of the 82 patients identified, indications for SIE prescription included 36 for venom allergies, 21 for food allergies, 11 for angioedema, 1 for drug allergy, 3 for immunotherapy, and 10 for unknown etiology. Initial SIEwas prescribed at the following clinical sites: 34 from allergy clinic, 40 from primary care clinic, 3 from emergency department, 1 from hospital discharge, and 4 from miscellaneous/unknown clinics. 37 patients (45%) were adherent to SIE prescription with an average of 9 prescription refills over approximately 10 years. 54 patients (55%) were non-adherent to SIE prescription, of which 20 patients (37%) never refilled after their initial prescription. Patients with venom allergies had the highest adherence rate of 62% (23 patients), while those with angioedema had the lowest rate of 27% (3 patients). CONCLUSIONS: This study shows that most patients do not have an active SIE prescription after approximately 10 years, of which 37% patients do not refill after their initial prescription.

Long-Term Adherence to Self-Injectable Epinephrine Prescription

Long-Term Adherence to Self-Injectable Epinephrine Prescription

Intention to prescribe self-injectable epinephrine: Are there differences depending on who assesses the patient post-reaction?

IntroductionAnaphylaxis is the most severe of all allergic reactions and can even prove fatal. There is limited evidence of a difference in prescribing patterns for self-injectable epinephrine (SIE) between general paediatricians and paediatricians with greater knowledge of allergology. ObjectivesAssess knowledge about prescribing SIE of a sample of primary care/hospital paediatricians and paediatricians with specialised knowledge of allergology through a questionnaire asking them about clinical cases of anaphylaxis in their daily paediatric practice. Materials and methodsParticipants were primary care and hospital paediatricians practicing in different regions of the province of Barcelona and paediatricians with specialised knowledge in the field of allergology from Spain. ResultsA total of 183 paediatricians responded. Of that 59.6% were paediatricians with specialised knowledge of allergology. General paediatricians in most cases correctly prescribed SIE device (more than 70% answered correctly in five of the eight clinical cases). In the case of drug anaphylaxis, which is an avoidable allergen for which SIE is not indicated, 67.5% of general paediatricians would prescribe it. In the case of exercise-induced anaphylaxis there were also differences in the prescription of epinephrine by general paediatricians, with only 40% prescribing it. ConclusionsIn this study the percentage of SIE prescriptions would be higher than expected by general paediatricians, with no differences in the cases proposed between them and the paediatricians with better knowledge of allergology.Despite these results, it is important to insist on conducting education programmes and disseminating them to facilitate physicians’ recognition and treatment of anaphylactic reactions.

A Multifaceted Intervention for Patients With Anaphylaxis Increases Epinephrine Use in Adult Emergency Department

Studies have documented inconsistent emergency anaphylaxis care and low compliance with published guidelines. To evaluate anaphylaxis management before and after implementation of an emergency department (ED) anaphylaxis order set and introduction of epinephrine autoinjectors, and to measure the effect on anaphylaxis guideline adherence. A cohort study was conducted from April 29, 2008, to August 9, 2012. Adult patients in the ED who were diagnosed with anaphylaxis were included. ED management, disposition, self-injectable epinephrine prescriptions, allergy follow-up, and incidence of biphasic reactions were evaluated. The study included 202 patients. The median age of the patients was 45.3 years (interquartile range, 31.3-56.4 years); 139 (69%) were women. Patients who presented after order set implementation were more likely to be treated with epinephrine (51% vs 33%; odds ratio [OR] 2.05 [95% CI, 1.04-4.04]) and admitted to the ED observation unit (65% vs 44%; OR 2.38 [95% CI, 1.23-4.60]), and less likely to be dismissed home directly from ED (16% vs 29%, OR 0.47 [95% CI, 0.22-1.00]). Eleven patients (5%) had a biphasic reaction. Of these, 5 (46%) had the biphasic reaction in the ED observation unit; 1 patient was admitted to the intensive care unit. Six patients (55%) had reactions within 6 hours of initial symptom resolution, of whom 2 were admitted to the intensive care unit. Significantly higher proportions of patients with anaphylaxis received epinephrine and were admitted to the ED observation unit after introduction of epinephrine autoinjectors and order set implementation. Slightly more than half of the biphasic reactions occurred within the recommended observation time of 4 to 6 hours. Analysis of these data suggests that the multifaceted approach to changing anaphylaxis management described here improved guideline adherence.

Anaphylaxis in America: The prevalence and characteristics of anaphylaxis in the United States

Although anaphylaxis is recognized as an important life-threatening condition, data are limited regarding its prevalence and characteristics in the general population. We sought to estimate the lifetime prevalence and overall characteristics of anaphylaxis. Two nationwide, cross-sectional random-digit-dial surveys were conducted. The public survey included unselected adults, whereas the patient survey captured information from household members reporting a prior reaction to medications, foods, insect stings, or latex and idiopathic reactions in the previous 10 years. In both surveys standardized questionnaires queried anaphylaxis symptoms, treatments, knowledge, and behaviors. The public survey included 1,000 adults, of whom 7.7% (95% CI, 5.7% to 9.7%) reported a prior anaphylactic reaction. Using increasingly stringent criteria, we estimate that 5.1% (95% CI, 3.4% to 6.8%) and 1.6% (95% CI, 0.8% to 2.4%) had probable and very likely anaphylaxis, respectively. The patient survey included 1,059 respondents, of whom 344 reported a history of anaphylaxis. The most common triggers reported were medications (34%), foods (31%), and insect stings (20%). Forty-two percent sought treatment within 15 minutes of onset, 34% went to the hospital, 27% self-treated with antihistamines, 10% called 911, 11% self-administered epinephrine, and 6.4% received no treatment. Although most respondents with anaphylaxis reported 2 or more prior episodes (19% reporting ≥5 episodes), 52% had never received a self-injectable epinephrine prescription, and 60% did not currently have epinephrine available. The prevalence of anaphylaxis in the general population is at least 1.6% and probably higher. Patients do not appear adequately equipped to deal with future episodes, indicating the need for public health initiatives to improve anaphylaxis recognition and treatment.

An update on venom allergy

Allergic reactions to stinging insects may be unexpected, frightening, and severe. A clear understanding of recent advances in the field facilitates appropriate care of children who experience severe reactions to hymenoptera stings. Recent investigations have underscored the importance of appropriate patient selection for potentially life-saving venom immunotherapy. Venom immunotherapy is effective in preventing future anaphylaxis from hymenoptera stings. Immunotherapy is indicated for patients with a history of anaphylaxis. Children who develop large local swelling or strictly cutaneous systemic reactions generally do not require immunotherapy. Component resolved diagnostic testing has been investigated to clarify the possibility of multiple venom allergies in patients with sensitization to multiple venoms. Rapid recognition and treatment of anaphylaxis are critical. Subsequent education about avoiding future stings and attention to emergency preparedness with appropriate prescription of self-injectable epinephrine is important. Referral of patients who have experienced venom-associated anaphylaxis for possible venom immunotherapy can prevent future severe episodes of anaphylaxis resulting from stings.

Current practices among allergists on writing self-injectable epinephrine prescriptions for immunotherapy patients

Current practices among allergists on writing self-injectable epinephrine prescriptions for immunotherapy patients

Prescriptions for self-injectable epinephrine in emergency department angioedema management

Angioedema is often treated in the emergency department (ED). Few studies have evaluated self-injectable epinephrine (SIE) prescribing patterns for angioedema. To describe presentation and management of ED patients with angioedema and determine factors associated with epinephrine administration, hospital admission and SIE prescription. We conducted a retrospective cohort study of all ED patients with angioedema between January 2005 and December 2006. Of 63 patients, 39 (61.9%) were female. Median age was 49 years. Precipitating factors were identified in 36 (57.1%) patients. History of other allergic conditions was seen in 37 (58.7%) patients. Seventeen (27.0%) patients received epinephrine, 55 (87.3%) received antihistamines, and 51 (81.0%) received steroids. Epinephrine was administered more commonly in patients with edema of the tongue (risk ratio [RR], 5.28, 95% confidence interval [CI] 1.95-14.33, P = .0003), tightness/fullness of throat (RR, 3.31, 95% CI 1.62-6.76, P = .006), and dyspnea/wheeze (RR, 3.04, 95% CI 1.41-6.59, P = .005). Hospitalization was more common in patients with dyspnea/wheeze (P = .028) and allergic history (P = .006). Thirteen patients (22.0%) were discharged with SIE. An SIE prescription was associated with younger patients (median age, 26 years [interquartile range (IQR) 15-50] vs a median age 57.5 years [IQR 43-68], P = .004) and patients with throat tightness/fullness (RR, 4.2, 95% CI 1.8-9.8, P = .005). Patients with respiratory symptoms and allergic history were likely to be admitted. Epinephrine use was more frequent in patients with signs and symptoms of oropharyngeal edema. Younger patients and those with tightness/fullness of throat were likely to be prescribed SIE. Further studies are needed to determine who would benefit from epinephrine use and SIE prescription.

Multiple epinephrine doses for stinging insect hypersensitivity reactions treated in the emergency department

Data are sparse on epinephrine treatment for stinging insect hypersensitivity (SIH) reactions. To establish the frequency of receiving more than 1 dose of epinephrine in patients presenting to the emergency department (ED) with SIH reactions. We performed a medical record review of all 153 patients with SIH reactions presenting to 3 EDs in Boston, Massachusetts, between January 1, 2001, and December 31, 2006. Patients were identified by International Classification of Diseases, Ninth Revision (ICD-9) codes (989.5, 995.0, and 995.3). We focused on clinical presentations and treatments, including epinephrine treatments given before and during the ED visit. The cohort was 54% male, with a median age of 33 years. Bees were the most frequently reported triggering insect (74%). A total of 59% of patients experienced large local reactions, whereas 36% had systemic reactions (10% cutaneous systemic and 26% anaphylaxis). The remaining 5% presented with normal local reactions to insect stings. Among patients with systemic reactions, 82% were stung within 3 hours of arrival at the ED. Most (60%) received treatments before arrival at the ED, including 26% who received epinephrine. While in the ED, these patients received antihistamines (76%), systemic corticosteroids (55%), and epinephrine (9%). Overall, 35% of patients with systemic reactions received epinephrine, and among this subset, 16% received more than 1 dose. Most patients with systemic reactions (67%) were discharged to home. At ED discharge, 68% received a prescription for self-injectable epinephrine, but only 11% had documentation of referral to an allergist. Among patients with systemic SIH reactions who received epinephrine, 16% received a second dose. Physicians should consider prescribing 2 doses of self-injectable epinephrine for patients at risk for systemic SIH reactions.

Current views on Self-injectable Epinephrine Prescriptions for Immunotherapy Patients

RATIONALE: Prescribing self-injectable epinephrine (SIE) is appropriate for patients with an increased risk of anaphylaxis, but there is no current consensus regarding the use of SIE prescriptions for patients on immunotherapy (IT). This study investigates current practices among allergists and those in-training on writing SIE prescriptions for IT patients.METHODS: A survey was sent to allergist-immunologists by email. Demographic information was obtained as well as information on their experience with IT and the role of SIE prescriptions for IT patients. Approval was obtained from the Long Island College Hospital IRB.RESULTS: 248 surveys were returned and 5 were excluded because they were incomplete. The majority of respondents were out of training (90%). Only 34.9% prescribe SIE to all of their patients on IT. 14.4% do not prescribe SIE for any of their IT patients. Of the remaining 50.6% of respondents, the three largest categories of patients prescribed SIE include: those with a history of previous systemic reaction, those on Omalizumab or those on Omalizumab and venom IT. Respondents who prescribe SIE for all of their patients have fewer years in practice (avg 14.5 years, range 0-44 years) compared to those who do not prescribe (avg 22 years, range 1-40 years) SIE. Interestingly, of those who prescribe SIE to all their IT patients, 61% give IT even if the patient fails to bring their SIE to their appointment.CONCLUSIONS: Among this sample of allergists there was a wide range of practices. Specific SIE prescribing recommendations for patients on IT may be helpful to practicing allergists. RATIONALE: Prescribing self-injectable epinephrine (SIE) is appropriate for patients with an increased risk of anaphylaxis, but there is no current consensus regarding the use of SIE prescriptions for patients on immunotherapy (IT). This study investigates current practices among allergists and those in-training on writing SIE prescriptions for IT patients. METHODS: A survey was sent to allergist-immunologists by email. Demographic information was obtained as well as information on their experience with IT and the role of SIE prescriptions for IT patients. Approval was obtained from the Long Island College Hospital IRB. RESULTS: 248 surveys were returned and 5 were excluded because they were incomplete. The majority of respondents were out of training (90%). Only 34.9% prescribe SIE to all of their patients on IT. 14.4% do not prescribe SIE for any of their IT patients. Of the remaining 50.6% of respondents, the three largest categories of patients prescribed SIE include: those with a history of previous systemic reaction, those on Omalizumab or those on Omalizumab and venom IT. Respondents who prescribe SIE for all of their patients have fewer years in practice (avg 14.5 years, range 0-44 years) compared to those who do not prescribe (avg 22 years, range 1-40 years) SIE. Interestingly, of those who prescribe SIE to all their IT patients, 61% give IT even if the patient fails to bring their SIE to their appointment. CONCLUSIONS: Among this sample of allergists there was a wide range of practices. Specific SIE prescribing recommendations for patients on IT may be helpful to practicing allergists.

Dietary Advice, Dietary Adherence and the Acquisition of Tolerance in Egg-Allergic Children: A 5-yr Follow-up

Allen CW, Kemp AS, Campbell DE. Pediatr Allergy Immunol. 2009;20(3):213–218 PURPOSE OF THE STUDY. To assess sources of dietary advice, adherence to advice, factors that influence adherence, and impact of dietary adherence on acquisition of tolerance among egg-allergic children. STUDY POPULATION. One hundred sixty-seven children diagnosed with immunoglobulin E–mediated egg allergy and followed by a tertiary pediatric allergy center in Australia. METHODS. In 2006, a questionnaire was mailed to parents of egg-allergic children who were seen in the clinic in 2003. The questionnaire included demographic data, initial and subsequent reaction history, and information on self-injectable epinephrine prescriptions. Reaction severity was categorized as grade 1 …

The natural history and epidemiology of insect venom allergy: clinical implications

Hymenoptera stings can cause severe systemic allergic reactions and occasionally fatal anaphylaxis, which contribute significantly to morbidity and deterioration in health-related quality of life. The latest epidemiological data confirm the importance of insect sting allergy as a cause of anaphylaxis. Despite the high prevalence of asymptomatic sensitization, the prevalence of sting-induced systemic reactions (SRs) is low. However, to date, no parameter has been identified that can predict who will have a future reaction and whether it will be a large local reaction or anaphylactic. The combination of several concomitant factors, which include environmental, genetics and individual factors, may account for the occurrence of a system reaction in individual patients. Several not completely known factors may be associated with the severity of systemic re-stings. As about 50% of subjects with fatal sting reactions had no documented history of a previous SR, greater insight of the natural history and risk factors is required, especially in asymptomatic sensitized subjects. For patients with SRs, prevention of future severe allergic reactions starts with referral to an emergency department, correct administration of epinephrine by medical staff, referral to an allergist and coaching for the self-administration of epinephrine. However, most insect sting victims failed to seek medical advice and hospital attendance does not always correlate with the severity of the allergic reaction. Moreover, only about one-third of patients received a prescription for self-injectable epinephrine and were officially referred to an allergist after being discharged, causing the non- or delayed prescription of specific immunotherapy. Significantly, this means that at least half of the sting fatalities in patients with a positive history could have been avoided through the timely administration of specific immunotherapy. These findings indicate the urgent need to educate the general population and doctors on the management of venom-allergic patients.