title: Pre-hospital treatment of bee and wasp induced anaphylactic reactions: a retrospective study.
abstract: BACKGROUND
  Bee and wasp stings are among the most common triggers of anaphylaxis in adults representing around 20% of fatal anaphylaxis from any cause. Data of pre-hospital treatment of bee and wasp induced anaphylactic reactions are sparse. This study aimed to estimate the incidence of bee and wasp induced anaphylactic reactions, the severity of the reactions and to correlate the pre-hospital treatment with the severity of the anaphylactic reaction.
  
  
  METHODS
  Retrospective and descriptive study based on data from the Mobile Emergency Care Units (MECUs) in the Region of Southern Denmark (2008 only for Odense and 2009-2014 for the whole region). Discharge summaries with diagnosis related to anaphylaxis according to the International Classification of Diseases 10 (ICD-10) were reviewed to identify bee and wasp induced anaphylactic reactions. The severity of the anaphylactic reaction was assessed according to Sampson's severity score and Mueller's severity score. Treatment was evaluated in relation to administration of adrenaline, glucocorticoids and antihistamine.
  
  
  RESULTS
  We identified 273 cases (Odense 2008 n = 14 and Region of Southern Denmark 2009-2014 n = 259) of bee and wasp induced anaphylaxis. The Incidence Rate was estimated to 35.8 cases per 1,000,000 person year (95% CI 25.9-48.2) in the Region of Southern Denmark during 2009-2014. According to Sampson's severity score, 65% (n = 177) of the cases were graded as moderate to severe anaphylaxis (grade 3-5). Almost one third of cases could not be graded according to Mueller's severity score. Adrenaline was administrated in 54% (96/177) of cases with moderate to severe anaphylaxis according to Sampson's severity score, compared to 88% receiving intravenous glucocorticoids (p < 0.001) and 91% receiving intravenous antihistamines (p < 0.001). Even in severe anaphylaxis (grade 5) adrenaline was administered in only 80% of the cases.
  
  
  CONCLUSIONS
  Treatment with adrenaline is not administered in accordance with international guidelines. However, making an assessment of the severity of the anaphylactic reaction is difficult in retrospective studies.
authors.affiliation: Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Sdr. Boulevard 29, Odense, DK-5000, Denmark. athamaica.ruiz.oropeza@rsyd.dk.
authors.forename: Athamaica
authors.initials: A
authors.lastname: Ruiz Oropeza
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Mobile Emergency Care Unit, Odense University Hospital, Odense, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Mikkelsen
authors.affiliation: Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Sdr. Boulevard 29, Odense, DK-5000, Denmark.
authors.forename: Carsten
authors.initials: C
authors.lastname: Bindslev-Jensen
authors.affiliation: Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Sdr. Boulevard 29, Odense, DK-5000, Denmark.
authors.forename: Charlotte G
authors.initials: CG
authors.lastname: Mortz
mesh_terms: D017677:Age Distribution; D000707:Anaphylaxis / Q000188:drug therapy* / Q000453:epidemiology; D000818:Animals; D001516:Bees; D003718:Denmark / Q000453:epidemiology; D004638:Emergency Treatment / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D019983:Guideline Adherence; D006633:Histamine Antagonists / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007299:Insect Bites and Stings / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012621:Seasons; D012720:Severity of Illness Index; D014863:Wasps
chemical_list: D005938:Glucocorticoids; D006633:Histamine Antagonists; D004837:Epinephrine
keywords: Anaphylaxis; Pre-hospital treatment; Severity