Short- and long-term management of cases of venom-induced anaphylaxis is suboptimal

Tritt, Ashley; Gabrielli, Sofianne; Zahabi, Sarah; Clarke, Ann E.; Moisan, Jocelyn; Eisman, Harley; Morris, Judy; Restivo, Léa; Shand, Greg; Ben‐Shoshan, Moshe

doi:10.1016/j.anai.2018.04.006

Cited by 11 publications

(6 citation statements)

References 33 publications

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“…Similarly, a study conducted by Arsenault et al discovered that during the COVID-19 pandemic, a decrease of 9-40% was observed in outpatient visits in 10 different countries. [61][62][63][64] Contrary to multiple studies demonstrating low proportion of allergist referrals after an anaphylactic episode, 39,[57][58][59] our results showed a high proportion of patients being referred to an allergist for further management, although without any statistical difference between the two study periods.…”

Section: Discussioncontrasting

confidence: 99%

Evaluation of treatment and long-term management of anaphylaxis in pediatric departments of Greece: a 2-year nationwide survey

Chiampou,

Douros,

Moriki

et al. 2024

Allergol Immunopathol

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Background: Anaphylaxis proportions of incidence are increasing globally. However, limited data are available regarding anaphylaxis in the pediatric population of Greece. Purpose: The aim of the study was to evaluate management of anaphylaxis in Greek pediatric departments. Methods: We performed a questionnaire-based study of children aged less than 16 years presenting with anaphylaxis in 10 national pediatric hospitals over a period of 2 years. Management of anaphylaxis was assessed prior to and after an informative intervention. Results: In all, 127 cases of anaphylaxis were identified. Epinephrine was administered in almost half of all cases (51.2%), predominantly through intramuscular route (88.5%), while the majority of anaphylaxis patients were treated with antihistamines (92.9%) and corticosteroids (70.1%). Epinephrine was more likely administered by physicians if the elicitor was a drug (P < 0.003). Regarding long-term management, an epinephrine auto-injector was prescribed in 66.9% of patients. Follow-up information was available for most of the patients (92.9%), the majority of whom (76.3%) were referred to an allergist. More than half of these patients (63.6%) had a documented allergy follow-up, which identified a causative allergen in 53.3% of cases. No statistically significant differences were recorded prior to and after the intervention regarding management of anaphylaxis. Conclusions: This nationwide study highlighted the necessity of further improvement in terms of anaphylaxis treatment and secondary prevention measures. This presupposes appropriate education and training of healthcare professionals, thus contributing to proper and comprehensive care of the pediatric population.

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Section: Discussioncontrasting

confidence: 99%

Evaluation of treatment and long-term management of anaphylaxis in pediatric departments of Greece: a 2-year nationwide survey

Chiampou,

Douros,

Moriki

et al. 2024

Allergol Immunopathol

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“…Adverse reactions to antivenom may be early or late developing due to the involvement of different pathological pathways, including early developing IgE anaphylaxis, early developing non-IgE-mediated anaphylactoid reactions, and the IgG and IgM mediated late developing adverse reaction of serum sickness [ 49 , 145 , 189 , 190 , 191 , 192 , 193 , 194 , 195 , 196 , 197 , 198 ]. However, premedication with adrenalin has been shown to significantly reduce the incidence of early adverse reactions [ 193 , 199 , 200 , 201 , 202 , 203 ].…”

Section: Issues and Controversies In Modern Medical Carementioning

confidence: 99%

Snakebite: When the Human Touch Becomes a Bad Touch

Fry

2018

Toxins

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Many issues and complications in treating snakebite are a result of poor human social, economic and clinical intervention and management. As such, there is scope for significant improvements for reducing incidence and increasing patient outcomes. Snakes do not target humans as prey, but as our dwellings and farms expand ever farther and climate change increases snake activity periods, accidental encounters with snakes seeking water and prey increase drastically. Despite its long history, the snakebite crisis is neglected, ignored, underestimated and fundamentally misunderstood. Tens of thousands of lives are lost to snakebites each year and hundreds of thousands of people will survive with some form of permanent damage and reduced work capacity. These numbers are well recognized as being gross underestimations due to poor to non-existent record keeping in some of the most affected areas. These underestimations complicate achieving the proper recognition of snakebite’s socioeconomic impact and thus securing foreign aid to help alleviate this global crisis. Antivenoms are expensive and hospitals are few and far between, leaving people to seek help from traditional healers or use other forms of ineffective treatment. In some cases, cheaper, inappropriately manufactured antivenom from other regions is used despite no evidence for their efficacy, with often robust data demonstrating they are woefully ineffective in neutralizing many venoms for which they are marketed for. Inappropriate first-aid and treatments include cutting the wound, tourniquets, electrical shock, immersion in ice water, and use of ineffective herbal remedies by traditional healers. Even in the developed world, there are fundamental controversies including fasciotomy, pressure bandages, antivenom dosage, premedication such as adrenalin, and lack of antivenom for exotic snakebites in the pet trade. This review explores the myriad of human-origin factors that influence the trajectory of global snakebite causes and treatment failures and illustrate that snakebite is as much a sociological and economic problem as it is a medical one. Reducing the incidence and frequency of such controllable factors are therefore realistic targets to help alleviate the global snakebite burden as incremental improvements across several areas will have a strong cumulative effect.

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“…Perception of severity by patients/carers and clinicians often differ, and are influenced by experience and recognition of symptoms. Patients, caregivers and healthcare professionals both underestimate and over-estimate severity [16][17][18][19][20][21][22][23]. Amongst industry and regulatory bodies, severity perception is skewed by different factors including brand reputation.…”

Section: Perception Of Severity Of Anaphylaxismentioning

confidence: 99%

“…Perhaps the best example of this is using epinephrine (adrenaline) administration as an indicator of severity. The majority of individuals presenting to Emergency Medical Services with symptoms of anaphylaxis are not given epinephrine [8], while in both community and hospital settings, the correlation between anaphylaxis and rescue epinephrine is poor, with both nonanaphylaxis events treated preemptively with epinephrine in some cases, while reactions which clearly meet diagnostic criteria for anaphylaxis are not [17][18][19][20][21][22][23]. There seems to be general consensus therefore the epinephrine use per se is not a useful marker of severity [8,14,25,26 && ].…”

Section: Perception Of Severity Of Anaphylaxismentioning

confidence: 99%

Grading the severity of anaphylaxis

Stafford

Turner

2023

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewDespite no global consensus on a definition of anaphylaxis, there is increasing recognition that just as allergic reactions lie on a spectrum of severity, the same is for anaphylaxis. A variety of severity scores exist in the literature. We review the approaches taken to develop these scores, and their relative advantages and disadvantages.Recent findingsThere have been four recent comparisons of published severity scores. All have highlighted the heterogeneity between scoring systems, and the lack of transferability from one approach to another. Notably, only one score has been developed using a data-driven approach, and none has undergone formal and comprehensive validation.SummaryIt is unclear whether a single severity score is achievable, or indeed desirable. If the aim is to guide management of acute reactions, then assignment of severity is not only unnecessary but might delay treatment and cause harm. Severity scores are needed in the research setting, but require an approach which can discriminate between reactions of similar but nonidentical severity (particularly, nonanaphylaxis reactions). Any approach should be fit for purpose, informed by patient and clinician experience, and ideally be data-driven to minimize subjective bias and facilitate objective validation.

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Short- and long-term management of cases of venom-induced anaphylaxis is suboptimal

Cited by 11 publications

References 33 publications

Evaluation of treatment and long-term management of anaphylaxis in pediatric departments of Greece: a 2-year nationwide survey

Evaluation of treatment and long-term management of anaphylaxis in pediatric departments of Greece: a 2-year nationwide survey

Snakebite: When the Human Touch Becomes a Bad Touch

Grading the severity of anaphylaxis

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