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

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Francuzik, Wojciech
Ruëff, Franziska
Bauer, Andrea
Bilò, Maria Beatrice
Cardona, Victoria
Christoff, George
Dölle-Bierke, Sabine
Ensina, Luis
Fernández Rivas, Montserrat
Hawranek, Thomas
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Elsevier B.V.
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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.
Anaphylaxis , Epinephrine (adrenaline) , Hymenoptera , Insect venom allergy , β-blockers
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