Life-threatening anaphylaxis to venom immunotherapy in a patient taking an angiotensin-converting enzyme inhibitor

Ober, Andrew I.; MacLean, James A.; Hannaway, Paul J.

doi:10.1016/s0091-6749(03)01940-7

Cited by 47 publications

(24 citation statements)

References 6 publications

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“…270 There have been other cases of unusually severe anaphylaxis in patients receiving VIT while taking an ACE inhibitor, which did not recur after the ACE inhibitor was discontinued. 271 No cases such as this have been reported in association with angiotensin receptor blockers.…”

Section: B-blockers and Ace Inhibitorsmentioning

confidence: 88%

Allergen immunotherapy: A practice parameter third update

Cox

Nelson

Lockey

et al. 2011

Journal of Allergy and Clinical Immunology

1,025

1,054

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Section: B-blockers and Ace Inhibitorsmentioning

confidence: 88%

Allergen immunotherapy: A practice parameter third update

Cox

Nelson

Lockey

et al. 2011

Journal of Allergy and Clinical Immunology

1,025

1,054

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“…The negative effect of ACEIs on the severity of anaphylactic reactions (potentialized by the concurrent use of β-blockers) has been confirmed by clinical and experimental studies. [26][27][28][29] A multicenter study conducted in a group of 962 HVA patients suggested that the use of ACEIs constitutes a risk of a severe reaction to an insect sting. 28 Patients with elevated bsT level (>11.4 ng/ml) have more severe (mostly cardiovascular) symptoms and a higher risk of the occurrence of HVA symptoms after subsequent stings than those with normal bsT levels.…”

Section: Clinical Manifestations Of Hymenoptera Venom Allergymentioning

confidence: 99%

Insect sting allergy in adults: key messages for clinicians

Nittner-Marszalska¹,

Cichocka‐Jarosz²

2015

Polish Archives of Internal Medicine

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In most affected persons, a Hymenoptera sting results in local itching and mild induration. There are some individuals, however, who additionally respond to a sting by developing sensitization manifested by the presence of venom-specific immunoglobulin E (IgE) antibodies (vsIgE) to various components of insect venoms (in honeybee venom, 12 allergens have been identified so far: Api m1 -Api m 12; in wasp venom, 5 allergens have been identified: Vesp v 1, V v 2, Vesp v 3, Vesp v5, and Ves v 6). 2 Venom sensitization is the key factor for but is not synonymous with venom allergy. Sensitization to Hymenoptera venoms may be asymptomatic (hypersensitivity not clinically relevant) or symptomatic defined as Hymenoptera--venom allergy (HVA). The asymptomatic sensitization is common and found in 9.3% to 40.7% of the general population and in 30% to 60% of beekeepers (which reflects the effect of exposition toThe occurrence of Hymenoptera-venom allergy Allergic reactions to insect bites result most frequently from stings of flying insects of the Hymenoptera order. From among over 100 000 species of Hymenoptera, the ones mainly responsible for sting reactions are usually honeybee (Apis mellifera) as well as wasps and hornets (eg, Vespula germanica, V. vulgaris, V. rufa, Vespae sp.). However, potential perpetrators of Hymenoptera allegry are diverse and vary with geography. In southern Europe, there are paper wasps (Polistinae subfamilies); in the United States, there are fire ants (Solenopsis invicta); and in Australia, there are Jack jumper ants (Myrmecia pilosula) that seem to cause more problems. A large number of Hymenoptera species, their ways of feeding, and their aggressive defense behavior result in as many as 56.6% to 94.5% of people experiencing at least 1 sting in their lives. ABSTRACTDuring their lifetime, 94.5% of people are stung by wasps, honeybees, hornets, or bumble-bees (order Hymenoptera). After a sting, most people show typical local symptoms, 5% to 15% develop local allergic reactions, and 3% to 8.9%-systemic allergic reactions (SARs), which may be potentially life-threatening in about 10% of them. In mild forms of Hymenoptera-venom allergy (HVA), the leading symptoms are urticaria and edema (grades I and II, respectively, according to the Mueller classification). Severe SARs are classified as grade III (respiratory symptoms) and IV (cardiovascular symptoms). Rare manifestations of HVA are Kounis syndrome and takotsubo cardiomyopathy. All patients after an SAR require standard (skin test, IgE, tryptase) or comprehensive (component diagnosis, basophil activation test) allergy testing. All patients with severe systemic symptoms (hypertension, disturbances in consciousness) should be tested for mastocytosis. Additionally, a relationship was found between the severity of HVA symptoms and intake of angiotensin-converting enzyme inhibitors (ACEIs). There is a similar concern, although less well-documented, about the use of β-blockers. Patients with HVA who have experienced a SAR are potential candidates for ...

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“…Often a combination of factors may have conspired to make the reaction fatal, including the severity of the allergy, a high dose of potent allergen, underlying genetic tendencies for angioedema, hypotension [21] and bronchospasm (recognized by previous idiopathic or allergen-triggered events), and concurrent disease [22] or medication [23] synergizing with these genetic tendencies. The recorded treatment was optimal in some cases, suboptimal in others, and some were untreated.…”

Section: What Made the Reactions Fatal?mentioning

confidence: 99%

“…Antihypertensive drugs such as angiotensin-converting enzyme inhibitors or beta-blockers may be a co-factor for anaphylaxis, particularly noted during insect venom hyposensitization [23]. Other series have reported the use of beta-blocker antihypertensive drugs and underlying coronary artery pathology in those dying from sting reactions [25], but this pattern was not seen in UK sting deaths.…”

Section: What Made the Reactions Fatal?mentioning

confidence: 99%

Anaphylaxis: can we tell who is at risk of a fatal reaction?

Pumphrey¹

2004

Current Opinion in Allergy &Amp; Clinical Immunology

297

230

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Most fatal anaphylactic reactions are unpredictable. The appropriate management after recovery from a severe reaction may be protective against a fatal recurrence. An accurate identification of the cause and effective avoidance is a crucial part of this management, together with effective treatment of asthma for those with food allergy, immunotherapy for sting allergy, the avoidance of drugs that potentiate anaphylaxis, and effective training in self-treatment.

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Life-threatening anaphylaxis to venom immunotherapy in a patient taking an angiotensin-converting enzyme inhibitor

Cited by 47 publications

References 6 publications

Allergen immunotherapy: A practice parameter third update

Allergen immunotherapy: A practice parameter third update

Insect sting allergy in adults: key messages for clinicians

Anaphylaxis: can we tell who is at risk of a fatal reaction?

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