Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Mar;75(3):535-545.
doi: 10.1111/all.13945. Epub 2019 Jul 16.

Risk factors and indicators of severe systemic insect sting reactions

Johanna Stoevesandt  1 , Gunter J Sturm  2   3 , Patrizia Bonadonna  4 , Joanna N G Oude Elberink  5 , Axel Trautmann  1
Affiliations
Review

Risk factors and indicators of severe systemic insect sting reactions

Johanna Stoevesandt et al. Allergy. 2020 Mar.

Abstract

Hymenoptera venom allergy ranks among the top three causes of anaphylaxis worldwide, and approximately one-quarter of sting-induced reactions are classified as severe. Fatal sting reactions are exceedingly rare, but certain factors may entail a considerably higher risk. Delayed administration of epinephrine and upright posture are situational risk factors which may determine an unfavorable outcome of the acute anaphylactic episode and should be addressed during individual patient education. Systemic mastocytosis and senior age are major, unmodifiable long-term risk factors and thus reinforce the indication for venom immunotherapy. Vespid venom allergy and male sex likewise augment the risk of severe or even fatal reactions. Further studies are required to assess the impact of specific cardiovascular comorbidities. Available data regarding potential effects of beta-blockers and/or ACE inhibitors in coexisting venom allergy are inconclusive and do not justify recommendations to discontinue guideline-directed antihypertensive treatment. The absence of urticaria/angioedema during sting-induced anaphylaxis is indicative of a severe reaction, serum tryptase elevation, and mast cell clonality. Determination of basal serum tryptase levels is an established diagnostic tool for risk assessment in Hymenoptera venom-allergic patients. Measurement of platelet-activating factor acetylhydrolase activity represents a complementary approach but is not available for routine diagnostic use.

Keywords: age; mastocytosis; medication; tryptase; venom.

PubMed Disclaimer

References

REFERENCES

    1. Muraro A, Roberts G, Worm M, et al. Anaphylaxis: guidelines from the European academy of allergy and clinical immunology. Allergy. 2014;69(8):1026-1045.
    1. Sturm GJ, Varga E-M, Roberts G, et al. EAACI guidelines on allergen immunotherapy: hymenoptera venom allergy. Allergy. 2018;73(4):744-764.
    1. Golden D, Demain J, Freeman T, et al. Stinging insect hypersensitivity: a practice parameter update 2016. Ann Allergy Asthma Immunol. 2017;118(1):28-54.
    1. Fernández J. Distribution of vespid species in Europe. Curr Opin Allergy Clin Immunol. 2004;4(4):319-324.
    1. Alfaya Arias T, Soriano Gómis V, Soto Mera T, et al. Key Issues in hymenoptera venom allergy: an update. J Investig Allergol Clin Immunol. 2017;27(1):19-31.

Substances