Triggers and Treatment of Anaphylaxis

Worm, Margitta; Eckermann, Oliver; Dölle, Sabine; Aberer, Werner; Beyer, Kirsten; Hawranek, Thomas; Hompes, S.; Koehli, Alice; Mahler, Vera; Nemat, Katja; Niggemann, B.; Pföhler, Claudia; Rabe, Uta; Reißig, Angelika; Rietschel, Ernst; Scherer, Kathrin; Treudler, Regina; Ruëff, Franziska

doi:10.3238/arztebl.2014.0367

Cited by 96 publications

(64 citation statements)

References 27 publications

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“…The release of vasoactive mediators into the circulation can lead to vascular collapse and anaphylactic shock. 72 Supplementary Table 1 summarizes the clinical manifestations of food allergies, the organ systems affected by IgE-mediated mast cell and basophil degranulation, and the clinical aspects of gastrointestinal food allergy. 3,6 …”

Section: Pathogenesis and Manifestations Of Food Allergymentioning

confidence: 99%

Food Allergies: The Basics

et al. 2015

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IgE-associated food allergy affects approximately 3% of the population and has severe effects on the daily life of patients—manifestations occur not only in the gastrointestinal tract but also affect other organ systems. Birth cohort studies have shown that allergic sensitization to food allergens develops early in childhood. Mechanisms of pathogenesis include cross-linking of mast cell– and basophil-bound IgE and immediate release of inflammatory mediators, as well as late-phase and chronic allergic inflammation, resulting from T-cell, basophil, and eosinophil activation. Researchers have begun to characterize the molecular features of food allergens and have developed chip-based assays for multiple allergens. These have provided information about cross-reactivity among different sources of food allergens, identified disease-causing food allergens, and helped us to estimate the severity and types of allergic reactions in patients. Importantly, learning about the structure of disease-causing food allergens has allowed researchers to engineer synthetic and recombinant vaccines.

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Section: Pathogenesis and Manifestations Of Food Allergymentioning

confidence: 99%

Food Allergies: The Basics

et al. 2015

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“…In contrast, potentially fatal severe systemic reactions often involve vascular and respiratory systems and can cause multiorgan failure [1]. Hymenoptera stings are among the most frequent causes of severe anaphylaxis in adults in Europe [2] and account for approximately 20% of the anaphylaxis-related fatalities worldwide [3]. The prevalence of systemic reactions ranges from 0.3-7.5% in European population [4] and from 0.5-3.3% in the United States [5], while in Latin America, Hymenoptera stings elicit about 15% of the severe allergic reactions annually reported [6].…”

Section: Introductionmentioning

confidence: 99%

Current challenges in molecular diagnostics of insect venom allergy

2020

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Background Advanced component-resolved diagnostics (CRD) in Hymenoptera venom allergy (HVA) has improved the precise description of individual sensitization profiles. However, diagnostic gaps, peptidebased cross-reactivity, early identification of severe reactors and diagnosis of patients with a clear history of sting reactions but negative specific IgE and skin tests, remain challenging. Methods Systematic literature search in PubMed and critical analysis of recently published studies on insect venom allergy diagnostics. Results and discussion CRD has increased the sensitivity of IgE testing and improved the discrimination of primary sensitization from irrelevant cross-reactivity, ultimately providing a better rationale for therapeutic decisions. Despite these major advances, there is still room for improvement in routine HVA diagnostics. Peptide based cross-reactivity among homologous allergens from Vespinae and Polistinae venoms as well as still existing diagnostic gaps are particularly challenging. No marker allergens are currently available to differentiate Vespula and Polistes sensitizations. Several strategies including clinical setting of basophil activation test (BAT) for routine diagnostics, venomic analysis for the identification of novel allergens and characterization of the molecular basis of A. Perez-Riverol · T. Jakob ( )

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“…Population-based studies have reported a prevalence of bee and wasp induced anaphylaxis ranging from 0.3 to 8.9% in adults and from 0.15 to 0.8% in children [2, 3]. Several studies have reported bee and wasp stings to be the most common trigger of anaphylactic reactions in adults [4, 5]. The incidence of fatalities due to bee and wasp induced anaphylactic reactions ranges from 0.3 to 0.48 cases per one million inhabitants per year, representing around 20% of fatal anaphylaxis from any cause [2, 3].…”

Section: Introductionmentioning

confidence: 99%

Pre-hospital treatment of bee and wasp induced anaphylactic reactions: a retrospective study

Oropeza

Mikkelsen

Bindslev‐Jensen

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundBee and wasp stings are among the most common triggers of anaphylaxis in adults representing around 20% of fatal anaphylaxis from any cause. Data of pre-hospital treatment of bee and wasp induced anaphylactic reactions are sparse. This study aimed to estimate the incidence of bee and wasp induced anaphylactic reactions, the severity of the reactions and to correlate the pre-hospital treatment with the severity of the anaphylactic reaction.MethodsRetrospective and descriptive study based on data from the Mobile Emergency Care Units (MECUs) in the Region of Southern Denmark (2008 only for Odense and 2009–2014 for the whole region). Discharge summaries with diagnosis related to anaphylaxis according to the International Classification of Diseases 10 (ICD-10) were reviewed to identify bee and wasp induced anaphylactic reactions. The severity of the anaphylactic reaction was assessed according to Sampson’s severity score and Mueller’s severity score. Treatment was evaluated in relation to administration of adrenaline, glucocorticoids and antihistamine.ResultsWe identified 273 cases (Odense 2008 n = 14 and Region of Southern Denmark 2009–2014 n = 259) of bee and wasp induced anaphylaxis. The Incidence Rate was estimated to 35.8 cases per 1,000,000 person year (95% CI 25.9–48.2) in the Region of Southern Denmark during 2009–2014. According to Sampson’s severity score, 65% (n = 177) of the cases were graded as moderate to severe anaphylaxis (grade 3–5). Almost one third of cases could not be graded according to Mueller’s severity score. Adrenaline was administrated in 54% (96/177) of cases with moderate to severe anaphylaxis according to Sampson’s severity score, compared to 88% receiving intravenous glucocorticoids (p < 0.001) and 91% receiving intravenous antihistamines (p < 0.001). Even in severe anaphylaxis (grade 5) adrenaline was administered in only 80% of the cases.ConclusionTreatment with adrenaline is not administered in accordance with international guidelines. However, making an assessment of the severity of the anaphylactic reaction is difficult in retrospective studies.

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Triggers and Treatment of Anaphylaxis

Abstract: Wasp and bee venom, legumes, animal proteins, and analgesic drugs were the commonest triggers of anaphylaxis. Their relative frequency was age-dependent. Epinephrine was given too rarely, as it is recommended in the guidelines for all cases of grade 2 and above.

Cited by 96 publications

References 27 publications

Food Allergies: The Basics

Food Allergies: The Basics

Current challenges in molecular diagnostics of insect venom allergy

Pre-hospital treatment of bee and wasp induced anaphylactic reactions: a retrospective study

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