Phenotype and risk factors of venom-induced anaphylaxis: A case-control study of the European Anaphylaxis Registry
Francuzik, Wojciech; Ruëff, Franziska; Bauer, Andrea; Bilò, Maria Beatrice; Cardona, Victoria; Christoff, George; Dölle-Bierke, Sabine; Ensina, Luis; Fernández Rivas, Montserrat; Hawranek, Thomas; Hourihane, Jonathan O'B.; Jakob, Thilo; Papadopoulos, Nicos G.; Pföhler, Claudia; Poziomkowska-Gesicka, Iwona; Van der Brempt, Xavier; Scherer Hofmeier, Kathrin; Treudler, Regina; Wagner, Nicola; Wedi, Bettina; Worm, Margitta
Date:
2020-06-22
Copyright:
© 2020, American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved. This manuscript version is made available under the CC BY-NC-ND 4.0 license.
Full text restriction information:
Access to this article is restricted until 12 months after publication by request of the publisher.
Restriction lift date:
2021-06-22
Citation:
Francuzik, W., Ruëff, F., Bauer, A., Bilò, M. B., Cardona, V., Christoff, G., Dölle-Bierke, S., Ensina, L., Rivas, M. F., Hawranek, T., Hourihane, J. O. B., Papadopoulos, G., Pföhler, C., Poziomkowska-Gęsicka, I., Van der Brempt, X., Scherer Hofmeier, K., Treudler, R., Wagner, N., Wedi, B. and Worm, M. (2020) ‘Phenotype and risk factors of venom-induced anaphylaxis: A case-control study of the European Anaphylaxis Registry’, Journal of Allergy and Clinical Immunology. doi: 10.1016/j.jaci.2020.06.008
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.
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