title: Predictors of severe systemic anaphylactic reactions in patients with Hymenoptera venom allergy: importance of baseline serum tryptase-a study of the European Academy of Allergology and Clinical Immunology Interest Group on Insect Venom Hypersensitivity.
abstract: BACKGROUND
  Severe anaphylaxis to honeybee or vespid stings is associated with a variety of risk factors, which are poorly defined.
  
  
  OBJECTIVE
  Our aim was to evaluate the association of baseline serum tryptase concentrations and other variables routinely recorded during patient evaluation with the frequency of past severe anaphylaxis after a field sting.
  
  
  METHODS
  In this observational multicenter study, we enrolled 962 patients with established bee or vespid venom allergy who had a systemic reaction after a field sting. Data were collected on tryptase concentration, age, sex, culprit insect, cardiovascular medication, and the number of preceding minor systemic reactions before the index field sting. A severe reaction was defined as anaphylactic shock, loss of consciousness, or cardiopulmonary arrest. The index sting was defined as the hitherto first, most severe systemic field-sting reaction. Relative rates were calculated with generalized additive models.
  
  
  RESULTS
  Two hundred six (21.4%) patients had a severe anaphylactic reaction after a field sting. The frequency of this event increased significantly with higher tryptase concentrations (nonlinear association). Other factors significantly associated with severe reactions after a field sting were vespid venom allergy, older age, male sex, angiotensin-converting enzyme inhibitor medication, and 1 or more preceding field stings with a less severe systemic reaction.
  
  
  CONCLUSIONS
  In patients with honeybee or vespid venom allergy, baseline serum tryptase concentrations are associated with the risk for severe anaphylactic reactions. Preventive measures should include substitution of angiotensin-converting enzyme inhibitors.
authors.affiliation: Department of Dermatology and Allergology, Ludwig-Maximilians-Universität, Munich, Germany. Franziska.Rueff@med.uni-muenchen.de
authors.forename: Franziska
authors.initials: F
authors.lastname: Ruëff
authors.forename: Bernhard
authors.initials: B
authors.lastname: Przybilla
authors.forename: Maria Beatrice
authors.initials: MB
authors.lastname: Biló
authors.forename: Ulrich
authors.initials: U
authors.lastname: Müller
authors.forename: Fabian
authors.initials: F
authors.lastname: Scheipl
authors.forename: Werner
authors.initials: W
authors.lastname: Aberer
authors.forename: Joëlle
authors.initials: J
authors.lastname: Birnbaum
authors.forename: Anna
authors.initials: A
authors.lastname: Bodzenta-Lukaszyk
authors.forename: Floriano
authors.initials: F
authors.lastname: Bonifazi
authors.forename: Christoph
authors.initials: C
authors.lastname: Bucher
authors.forename: Paolo
authors.initials: P
authors.lastname: Campi
authors.forename: Ulf
authors.initials: U
authors.lastname: Darsow
authors.forename: Cornelia
authors.initials: C
authors.lastname: Egger
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Haeberli
authors.forename: Thomas
authors.initials: T
authors.lastname: Hawranek
authors.forename: Michael
authors.initials: M
authors.lastname: Körner
authors.forename: Iwona
authors.initials: I
authors.lastname: Kucharewicz
authors.forename: Helmut
authors.initials: H
authors.lastname: Küchenhoff
authors.forename: Roland
authors.initials: R
authors.lastname: Lang
authors.forename: Oliviero
authors.initials: O
authors.lastname: Quercia
authors.forename: Norbert
authors.initials: N
authors.lastname: Reider
authors.forename: Maurizio
authors.initials: M
authors.lastname: Severino
authors.forename: Michael
authors.initials: M
authors.lastname: Sticherling
authors.forename: Gunter Johannes
authors.initials: GJ
authors.lastname: Sturm
authors.forename: Brunello
authors.initials: B
authors.lastname: Wüthrich
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000097:blood / Q000201:enzymology / Q000453:epidemiology*; D000818:Animals; D001514:Bee Venoms / Q000276:immunology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology*; D007299:Insect Bites and Stings / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D053802:Tryptases / Q000097:blood*; D014863:Wasps / Q000276:immunology*
chemical_list: D001514:Bee Venoms; D053802:Tryptases