Phenotype and risk factors of venom-induced anaphylaxis: A case-control study of the European Anaphylaxis Registry.

Abstract

BACKGROUND:

Venom-induced anaphylaxis (VIA) is a common, potentially life-threatening hypersensitivity reaction associated with (1) a specific symptom profile, 2) specific cofactors, and 3) specific management. Identifying the differences in phenotypes of anaphylaxis is crucial for future management guidelines and development of a personalized medicine approach.

OBJECTIVE:

This study aimed to evaluate the phenotype and risk factors of VIA.

METHODS:

Using data from the European Anaphylaxis Registry (12,874 cases), we identified 3,612 patients with VIA and analyzed their cases in comparison with sex- and age-matched anaphylaxis cases triggered by other elicitors (non-VIA cases [n = 3,605]).

RESULTS:

VIA more frequently involved more than 3 organ systems and was associated with cardiovascular symptoms. The absence of skin symptoms during anaphylaxis was correlated with baseline serum tryptase level and was associated with an increased risk of a severe reaction. Intramuscular or intravenous epinephrine was administered significantly less often in VIA, in particular, in patients without a history of anaphylaxis. A baseline serum tryptase level within the upper normal range (8-11.5 ng/mL) was more frequently associated with severe anaphylaxis.

CONCLUSION:

Using a large cohort of VIA cases, we have validated that patients with intermediate baseline serum tryptase levels (8-11 ng/mL) and without skin involvement have a higher risk of severe VIA. Patients receiving β-blockers or angiotensin-converting enzyme inhibitors had a higher risk of developing severe cardiovascular symptoms (including cardiac arrest) in VIA and non-VIA cases. Patients experiencing VIA received epinephrine less frequently than did cases with non-VIA.

• Authors: Wojciech Francuzik, Franziska Ruëff, Andrea Bauer, Maria Beatrice Bilò, Victoria Cardona, George Christoff, Sabine Dölle-Bierke, Luis Ensina, Montserrat Fernández Rivas, Thomas Hawranek, Jonathan O'B Hourihane, Thilo Jakob, Nicos G Papadopoulos, Claudia Pföhler, Iwona Poziomkowska-Gęsicka, Xavier Van der Brempt, Kathrin Scherer Hofmeier, Regina Treudler, Nicola Wagner, Bettina Wedi, Margitta Worm
• Journal: The Journal of allergy and clinical immunology (J Allergy Clin Immunol) Vol. 147 Issue 2 Pg. 653-662.e9 (02 2021) ISSN: 1097-6825 [Electronic] United States
• PMID: 32585173 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 American Academy of Allergy, Asthma & Immunology. All rights reserved.

Chemical References

• Arthropod Venoms

Topics

• Adult
• Anaphylaxis (etiology, physiopathology, therapy)
• Arthropod Venoms (adverse effects)
• Case-Control Studies
• Child
• Cohort Studies
• Europe
• Female
• Humans
• Insect Bites and Stings (complications)
• Male
• Phenotype
• Registries
• Risk Factors