title: Longitudinal study of 954 patients with stinging insect anaphylaxis.
abstract: BACKGROUND
  Stinging insect anaphylaxis (SIA) is a common cause of anaphylaxis and is potentially life-threatening.
  
  
  OBJECTIVE
  To examine US patients with an emergency department (ED) visit or hospitalization for SIA to evaluate postdischarge follow-up care.
  
  
  METHODS
  We identified all patients with an ED visit or hospitalization for SIA during 2002-2008 in the MarketScan Database using International Classification of Diseases, Ninth Revision, Clinical Modification codes (index date was the initial ED visit or hospitalization). Patients were required to have continuous full insurance coverage for 1 year or more before and after index. We examined patient factors during the preindex period, characteristics of the index event, and outcomes during the postindex period. Multivariable logistic regression was used to identify independent predictors of receiving preventive anaphylaxis care.
  
  
  RESULTS
  We identified 954 patients with an ED visit or hospitalization for SIA (mean [SD] age, 46 [19] years; 41% female). A total of 85% of patients were discharged directly from the ED. For those hospitalized, the mean hospital stay was 1 day, and 50% spent time in the intensive care unit. Cardiorespiratory failure occurred in 27% of those hospitalized. During the postindex period, 69% filled 1 or more epinephrine autoinjector prescription, but only 14% had 1 or more allergist/immunologist visit. Independent factors associated with receiving preventive anaphylaxis care during the postindex period were higher household income, no ED visit (for any reason) in the preindex period, and no cardiorespiratory arrest or failure during the index event.
  
  
  CONCLUSIONS
  Although two-thirds of patients filled a prescription for an epinephrine autoinjector after an ED visit or hospitalization for SIA, only 14% of patients received follow-up care by an allergist/immunologist. This missed opportunity to provide venom immunotherapy, an essentially curative therapy, unnecessarily places patients at risk for recurrent anaphylaxis.
authors.affiliation: Department of Pediatrics, Division of Asthma and Allergy, Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence, Rhode Island, USA. srudders@lifespan.org
authors.forename: Susan A
authors.initials: SA
authors.lastname: Rudders
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.forename: Wenhui
authors.initials: W
authors.lastname: Wei
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000453:epidemiology* / Q000209:etiology; D000818:Animals; D001993:Bronchodilator Agents; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004837:Epinephrine; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007299:Insect Bites and Stings / Q000150:complications / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001993:Bronchodilator Agents; D004837:Epinephrine