Predictors of severe anaphylaxis in Hymenoptera venom allergy. The importance of absence of urticaria and angioedema. Miércoles 19 de agosto
Predictors of severe anaphylaxis in Hymenoptera venom allergy
The importance of absence of urticaria and angioedema
Authors: Maria Chapsa, MD Henriette Roensch, MSScMathias Langner, MScStefan Beissert, MDAndrea Bauer, MD
Abstract
Background
Severe anaphylaxis (SA) in Hymenoptera venom allergy has been associated with a number of risk factors. However, the effect of several of those risk factors on the severity of anaphylaxis is poorly defined.
Objective
To evaluate risk factors for SA in Hymenoptera venom allergy.
Methods
We evaluated data from 500 patients who were referred to our department for the diagnosis of Hymenoptera venom allergy during a period of 11 years to identify risk factors for SA.
Results
Six significant risk factors for SA were identified ( P < .05): short interval from sting to reaction, absence of urticaria or angioedema (U/A) during anaphylaxis, older age, male sex, elevation of baseline serum tryptase (BST) level, and diagnosis of systemic mastocytosis. Moreover, elevation in BST level was significantly associated with the absence of U/A and older age. No association could be established between SA and comorbidities, concurrent cardiovascular medication, or the severity of the systemic reaction during the initiation of venom immunotherapy.
Conclusion
Apart from BST and older age, male sex, short interval from sting to reaction, and absence of U/A are also risk factors for SA. The association between elevated BST level and SA was largely confined to those who had an absence of U/A after field sting, possibly because of the higher risk of concurrent systemic mastocytosis. Patients with an SA after a field sting do not have an elevated risk of systemic reactions during the initiation of venom immunotherapy compared with patients with mild anaphylaxis; therefore, additional preventive measures are not necessary
En concordancia con este artículo, hay estudios previos que han medido predictores de reacciones anafilácticas sistémicas graves en pacientes con alergia al veneno de himenópteros, encontré uno similar que fue realizado en el 2009 por el Dr. Franziska Rusff et al. en comparación con este artículo actual los factores de riesgos fueron niveles de triptasa elevados, la edad avanzada, el sexo masculino, el uso de IECAS y 1 o más picaduras de anteriores con una reacción sistémica. Este artículo no relaciona el uso de IECAS como predictor de reacciones anafilácticas sistémicas graves.
ResponderEliminarY un artículo publicado JIACI en el 2018 quisieron evaluar si la variación (aumento o disminución) de la triptasa sérica en el primer día de inmunoterapia a veneno de himenópteros estaba asociada o no con la probabilidad de futuras reacciones adversas sistémicas (SAR) durante el tratamiento y lo que se encontró fue una asociación significativa entre el aumento de la triptasa sérica en el primer día de la inmunoterapia y la futura reacciones (relación de riesgo, 7,6). Esta elevación fue INDEPENDIENTE del día programado de la inmunoterapia, la gravedad de la reacción sistémica y el valor de triptasa sérica de línea base.
ResponderEliminarJ Investig Allergol Clin Immunol 2018; Vol 28(5) : 305-311. doi: 10.18176/jiaci.0258