BACKGROUND: Data are sparse on epinephrine treatment for stinging insect hypersensitivity (SIH) reactions. OBJECTIVE: To establish the frequency of receiving more than 1 dose of epinephrine in patients presenting to the emergency department (ED) with SIH reactions. METHODS: We performed a medical record review of all 153 patients with SIH reactions presenting to 3 EDs in Boston, Massachusetts, between January 1, 2001, and December 31, 2006. Patients were identified by International Classification of Diseases, Ninth Revision (ICD-9) codes (989.5, 995.0, and 995.3). We focused on clinical presentations and treatments, including epinephrine treatments given before and during the ED visit. RESULTS: The cohort was 54% male, with a median age of 33 years. Bees were the most frequently reported triggering insect (74%). A total of 59% of patients experienced large local reactions, whereas 36% had systemic reactions (10% cutaneous systemic and 26% anaphylaxis). The remaining 5% presented with normal local reactions to insect stings. Among patients with systemic reactions, 82% were stung within 3 hours of arrival at the ED. Most (60%) received treatments before arrival at the ED, including 26% who received epinephrine. While in the ED, these patients received antihistamines (76%), systemic corticosteroids (55%), and epinephrine (9%). Overall, 35% of patients with systemic reactions received epinephrine, and among this subset, 16% received more than 1 dose. Most patients with systemic reactions (67%) were discharged to home. At ED discharge, 68% received a prescription for self-injectable epinephrine, but only 11% had documentation of referral to an allergist. CONCLUSIONS: Among patients with systemic SIH reactions who received epinephrine, 16% received a second dose. Physicians should consider prescribing 2 doses of self-injectable epinephrine for patients at risk for systemic SIH reactions.
BACKGROUND: Data are sparse on epinephrine treatment for stinging insect hypersensitivity (SIH) reactions. OBJECTIVE: To establish the frequency of receiving more than 1 dose of epinephrine in patients presenting to the emergency department (ED) with SIH reactions. METHODS: We performed a medical record review of all 153 patients with SIH reactions presenting to 3 EDs in Boston, Massachusetts, between January 1, 2001, and December 31, 2006. Patients were identified by International Classification of Diseases, Ninth Revision (ICD-9) codes (989.5, 995.0, and 995.3). We focused on clinical presentations and treatments, including epinephrine treatments given before and during the ED visit. RESULTS: The cohort was 54% male, with a median age of 33 years. Bees were the most frequently reported triggering insect (74%). A total of 59% of patients experienced large local reactions, whereas 36% had systemic reactions (10% cutaneous systemic and 26% anaphylaxis). The remaining 5% presented with normal local reactions to insect stings. Among patients with systemic reactions, 82% were stung within 3 hours of arrival at the ED. Most (60%) received treatments before arrival at the ED, including 26% who received epinephrine. While in the ED, these patients received antihistamines (76%), systemic corticosteroids (55%), and epinephrine (9%). Overall, 35% of patients with systemic reactions received epinephrine, and among this subset, 16% received more than 1 dose. Most patients with systemic reactions (67%) were discharged to home. At ED discharge, 68% received a prescription for self-injectable epinephrine, but only 11% had documentation of referral to an allergist. CONCLUSIONS: Among patients with systemic SIH reactions who received epinephrine, 16% received a second dose. Physicians should consider prescribing 2 doses of self-injectable epinephrine for patients at risk for systemic SIH reactions.
Authors: John E Moffitt; David B K Golden; Robert E Reisman; Rufus Lee; Richard Nicklas; Theodore Freeman; Richard deshazo; James Tracy; I Leonard Bernstein; Joann Blessing-Moore; David A Khan; David M Lang; Jay M Portnoy; Diane E Schuller; Sheldon L Spector; Steven A Tilles Journal: J Allergy Clin Immunol Date: 2004-10 Impact factor: 10.793
Authors: Kari Bohlke; Robert L Davis; Frank DeStefano; S Michael Marcy; M Miles Braun; Robert S Thompson Journal: J Allergy Clin Immunol Date: 2004-03 Impact factor: 10.793
Authors: Sunday Clark; S Allan Bock; Theodore J Gaeta; Barry E Brenner; Rita K Cydulka; Carlos A Camargo Journal: J Allergy Clin Immunol Date: 2004-02 Impact factor: 10.793
Authors: David B K Golden; Anne Kagey-Sobotka; Philip S Norman; Robert G Hamilton; Lawrence M Lichtenstein Journal: N Engl J Med Date: 2004-08-12 Impact factor: 91.245
Authors: Ronna L Campbell; Anuradha Luke; Amy L Weaver; Jennifer L St Sauver; Eric J Bergstralh; James T Li; Veena Manivannan; Wyatt W Decker Journal: Ann Allergy Asthma Immunol Date: 2008-12 Impact factor: 6.347
Authors: F Estelle R Simons; Ledit R F Ardusso; M Beatrice Bilò; Yehia M El-Gamal; Dennis K Ledford; Johannes Ring; Mario Sanchez-Borges; Gian Enrico Senna; Aziz Sheikh; Bernard Y Thong Journal: World Allergy Organ J Date: 2011-02-23 Impact factor: 4.084
Authors: W Scott Russell; Judith Rosen Farrar; Richard Nowak; Daniel P Hays; Natalie Schmitz; Joseph Wood; Judi Miller Journal: World J Emerg Med Date: 2013
Authors: Manisha Manmohan; Sabine Müller; Michèle Myriam Rauber; Frank Koberne; H Reisch; Joachim Koster; Richard Böhm; Martin Messelken; Matthias Fischer; Thilo Jakob Journal: Allergo J Int Date: 2018-01-16
Authors: Nandinee Patel; Kok Wee Chong; Alexander Y G Yip; Despo Ierodiakonou; Joan Bartra; Robert J Boyle; Paul J Turner Journal: J Allergy Clin Immunol Date: 2021-04-20 Impact factor: 10.793