Diagnosis and Management of Insect Allergy: Barriers and Facilitators in the United States

Abstract

While guidelines recommend testing and treatment for patients with venom-induced anaphylaxis to prevent morbidity and mortality, significant barriers prevent most patients from receiving the evaluation and treatments that they need. This review examines these barriers in the United States along with the facilitators that can be used to overcome them.

Patient History Is Often Reliable in Cases of Venom-Induced Anaphylaxis: A Retrospective Observational Study

“…2 Among the barriers to diagnosis and management of insect hypersensitivity is the need for allergy testing for the selection of immunotherapy extracts prior to immunotherapy. 3 Testing is generally performed after a theoretical 6-week refractory period following an anaphylactic event, by an allergist that performs and interprets venom allergy testing varies. Testing options include skin and serum tests, with current guidelines recommending skin testing followed by serum testing when results are negative.…”

“…Commencing with rush immunotherapy on the day of anaphylaxis may help overcome barriers to initiation with immunotherapy, but does not address many of the barriers that remain for long-term adherence with the maintenance phase, for which additional research is needed. 3 This approach may be especially useful for patients identifying ants as the cause of a reaction in areas where fire ants are prevalent. For patients with reactions triggered by other types of Hymenoptera, this strategy would be useful to a much smaller proportion of patients, and would rely on expertise in identification of the insects or their nests by experts.…”