Anaphylaxis and insect allergy.
OBJECTIVE
Anaphylaxis is an acute-onset and potentially life-threatening allergic reaction that can be caused by numerous allergic triggers including stinging insects. This review focuses on recent advances, natural history, risk factors and therapeutic considerations.


RESULTS
Recent work suggests that concerns over insect allergy diagnosis continue to exist. This is especially true with individuals who have a convincing history of a serious life-threatening anaphylactic event, but lack the necessary diagnostic criteria of venom-specific IgE by skin test or in-vitro diagnostic methods to confirm the diagnosis. The role of occult mastocytosis or increased basophile reactivity may play a role in this subset population. Additionally, epinephrine continues to be underutilized as the primary acute intervention for an anaphylactic reaction in the emergent setting.


CONCLUSIONS
The incidence of anaphylaxis continues to rise across all demographic groups, especially those less than 20 years of age. Fortunately, the fatalities related to anaphylaxis appear to have decreased over the past decades. Our understanding of various triggers, associated risk factors, as well as an improved understanding and utilization of biological markers such as serum tryptase have improved. Our ability to treat insect anaphylaxis by venom immunotherapy is highly effective. Unfortunately, anaphylaxis continues to be underappreciated and undertreated especially in regard to insect sting anaphylaxis. This includes the appropriate use of injectable epinephrine as the primary acute management tool. These findings suggest that continued education of the general population, primary care healthcare providers and emergency departments is required.
Demain
Jeffrey G
JG
Allergy Asthma & Immunology Center of Alaska, Anchorage, Alaska 99508, USA. jdemain@allergyalaska.com
Minaei
Ashley A
AA
Tracy
James M
JM
D000293:Adolescent; D000367:Age Factors; D000368:Aged; D000707:Anaphylaxis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000276:immunology; D000818:Animals; D001180:Arthropod Venoms / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D006927:Hymenoptera / Q000276:immunology*; D006967:Hypersensitivity / Q000150:complications* / Q000276:immunology; D007167:Immunotherapy; D007299:Insect Bites and Stings / Q000276:immunology; D008875:Middle Aged; D055815:Young Adult
D001180:Arthropod Venoms