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.
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.
Ruëff
Franziska
F
Department of Dermatology and Allergology, Ludwig-Maximilians-Universität, Munich, Germany. Franziska.Rueff@med.uni-muenchen.de
Przybilla
Bernhard
B
Biló
Maria Beatrice
MB
Müller
Ulrich
U
Scheipl
Fabian
F
Aberer
Werner
W
Birnbaum
Joëlle
J
Bodzenta-Lukaszyk
Anna
A
Bonifazi
Floriano
F
Bucher
Christoph
C
Campi
Paolo
P
Darsow
Ulf
U
Egger
Cornelia
C
Haeberli
Gabrielle
G
Hawranek
Thomas
T
Körner
Michael
M
Kucharewicz
Iwona
I
Küchenhoff
Helmut
H
Lang
Roland
R
Quercia
Oliviero
O
Reider
Norbert
N
Severino
Maurizio
M
Sticherling
Michael
M
Sturm
Gunter Johannes
GJ
Wüthrich
Brunello
B
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*
D001514:Bee Venoms; D053802:Tryptases