Management of stinging insect hypersensitivity: a 5-year retrospective medical record review.
BACKGROUND
The Joint Task Force on Practice Parameters for Allergy and Immunology recommends that patients with a history of a systemic reaction to an insect sting be educated on ways to avoid insect stings, carry injectable epinephrine for emergency self-treatment, undergo specific IgE testing for stinging insect sensitivity, and be considered for immunotherapy.


OBJECTIVE
To review frontline providers' documented care and recommendations for imported fire ant and flying insect hypersensitivity reactions.


METHODS
A retrospective medical record review was performed of emergency department and primary care clinic visits between November 1, 1999, and November 30, 2004. Using International Classification of Diseases, Ninth Revision, codes, medical records were selected for review to identify patients with potential insect hypersensitivity.


RESULTS
A total of 769 medical records from patients who experienced an insect sting were reviewed. Of 120 patients with a systemic reaction, 66 (55.0%) received a prescription for injectable epinephrine, and 14 (11.7%) were given information regarding avoidance of the offending insect. Forty-seven patients with systemic reactions (39.2%) were referred to an allergist. Of 28 patients who kept their appointments and underwent skin testing, 3 had negative results and 25 (89%) had positive results and were advised to start immunotherapy.


CONCLUSIONS
Adherence to the stinging insect hypersensitivity practice parameter recommendations is poor. Many patients who have experienced a systemic reaction after an insect sting and have sought medical care are not afforded an opportunity for potentially lifesaving therapy.
Johnson
Thomas
T
Allergy/Immunology, Wilford Hall Medical Center, Lackland AFB, Texas 78236, USA. thomas.johnson2@lackland.af.mil
Dietrich
Jeffrey
J
Hagan
Larry
L
D000293:Adolescent; D000328:Adult; D000486:Allergy and Immunology / Q000592:standards*; D002648:Child; D003888:Desensitization, Immunologic; D004837:Epinephrine / Q000627:therapeutic use; D019983:Guideline Adherence; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000628:therapy*; D007299:Insect Bites and Stings / Q000276:immunology*; D008499:Medical Records; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D012189:Retrospective Studies
D006634:Histamine H1 Antagonists; D004837:Epinephrine