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Allergology Review

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  Authority of Polish Society of Allergology

vol 19. no 1. March 2014  

 Review articles
Anaphylaxis to insect venom
Ewa Cichocka-Jarosz

Insects responsible for allergic reactions almost exclusively belong to Hymenoptera and include honey bee (Apis mellifera), bumblebee (Bombus), wasp (Vespula vulgaris, Vespula germanica), hornet (Vespa crabro). Insect venom comprises 10-50 kDa glycoproteins and enzymes responsible for the allergic reaction, numerous small-molelcule chemicals and locally toxic peptides. The lifetime risk of being stung is 30%. Insect stings are the third most frequent cause of anaphylaxis in adults (preceded only by food and drugs anaphylaxis), and the second one in children (preceded only by food). Insect venom hypersensitivity is based primarily on IgE-dependent mechanism. In majority reports generalized allergic reactions (anaphylactic), are rare, reaching frequency 7.5% in adults, while more than ten times less (0.5-6.5%, this higher frequency is reported in atopic children and in some ethnic groups) in children. Fatalities due to insect stings comprises 0.246 deaths/1 milion people/year. In beekeepers and other professions of high insect sting exposure, both local and generalized reactions are more frequent in comparison to general population. Additional agents and cofactors may contribute to higher risk of episode of anaphylaxis and/or more severe course of insect sting reaction. Diagnosis of anaphylaxis is clinical in its character. Classification of general reaction is based on 4-grade Mueller’s scale. Intramuscular administration of epinephrine (to antero-lateral part of quadriceps muscle), oxygen supplementation, intravenous fluid resuscitation are the mainstay of medical intervention in anaphylaxis. All patients with a history of insect sting anaphylaxis should be supplied with autosyringe of epinephrine for self-medication. The goals of allergist consultation are diagnosis, establishing indications and contraindications to venom allergen immunotherapy, as well as patient’s education on prevention and self-medication.

keywords: anafilaksja, użądlenia owadów, jad, diagnostyka, alergenowa immunoterapia, anaphylaxis, insect stings, venom, diagnosis, allergen immunotherapy

pages: from 10 to 15

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