title: Stinging the Conscience: A Case of Severe Hymenoptera Anaphylaxis and the Need for Provider Awareness.
abstract: Hymenoptera venom allergy accounts for approximately 17% of all cases of anaphylaxis. Insect stings are a common occurrence across the world, with significant impact on active duty personnel. Venom immunotherapy (VIT) provides an effective treatment for those with systemic reactions to insect stings and other similar indications. We present a case of severe reaction to hymenoptera venom requiring an epinephrine drip and provide an overview for primary care providers on who should be referred to allergy or an allergist, carry an epinephrine auto-injector, and be a candidate for VIT. As this case demonstrates, such a framework is critical as even patients with a history of severe reactions may have a delay in referral to specialty care. The preventable morbidity and mortality associated with hymenoptera venom allergy represents a clear imperative to identify those service members at risk for future systemic symptoms and to refer them for assessment and VIT therapy. Allergy evaluation and treatment with VIT affords the opportunity for service members to be retained in the military and remain medically fit and ready for deployment around the world.
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda MD 20889.
authors.forename: Kyle
authors.initials: K
authors.lastname: Mikals
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda MD 20889.
authors.forename: Douglas
authors.initials: D
authors.lastname: Beakes
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda MD 20889.
authors.forename: Taylor A
authors.initials: TA
authors.lastname: Banks
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000707:Anaphylaxis / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D000818:Animals; D001364:Awareness; D002983:Clinical Competence / Q000592:standards*; D004837:Epinephrine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D006927:Hymenoptera; D007167:Immunotherapy / Q000379:methods; D007299:Insect Bites and Stings / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008889:Military Personnel; D010820:Physicians / Q000592:standards; D014862:Wasp Venoms / Q000009:adverse effects*
chemical_list: D014862:Wasp Venoms; D004837:Epinephrine