Maria Beatrice Bilò1, Matteo Martini2, Valerio Pravettoni3, Donatella Bignardi4, Patrizia Bonadonna5, Gabriele Cortellini6, Magdalena Kosinska7, Donatella Macchia8, Marina Mauro9, Elisa Meucci8, Marita Nittner-Marszalska7, Vincenzo Patella10, Roberta Pio11, Oliviero Quercia12, Federico Reccardini13, Erminia Ridolo14, Michael Rudenko15, Maurizio Severino8. 1. Allergy Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy. 2. Allergy and Clinical Immunology School, Università Politecnica delle Marche, Ancona, Italy. 3. General Medicine, Immunology and Allergy Unit - IRCCS Foudation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 4. UOC Allergologia Ospedale Policlinico San Martino, Genova, Italy. 5. U.S.D. Allergology Integrated University-Hospital of Verona, Verona, Italy. 6. Allergy Unit, Internal Medicine Department, Rimini Hospital, Local Health Unit of Romagna, Rimini, Italy. 7. Department of Internal Diseases and Allergology, Medical University of Wroclaw, Wroclaw, Poland. 8. Allergy Unit, Hospital S. Giovanni di Dio, Florence, Italy. 9. UOS Allergology, ASST Lariana Sant'Anna Hospital, Como, Italy. 10. Division Allergy and Clinical Immunology, Department of Medicine ASL Salerno, "Santa Maria della Speranza" Hospital, Salerno, Italy. 11. A.O.U San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy. 12. High Specialization Unit of Allergology, Hospital of Faenza, AUSL (Local Health Unit) of Romagna, Faenza, Italy. 13. SOC Pneumologia-Fisiopatologia Respiratoria, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy. 14. Allergologia e Immunologia Clinica, Dipartimento di Medicina e Chirurgia, Università degli studi di Parma, Parma, Italy. 15. London Allergy and Immunology Centre, London, UK.
Abstract
BACKGROUND: Large local reaction to Hymenoptera stings is usually defined as a swelling >10 cm which lasts longer than 24 hours, sometimes associated with erythema, pruritus and blisters. Currently, the risk of subsequent systemic reactions after re-stings is considered low (2%-15%). Therefore, a diagnostic workup in case of large local reaction is often judged unnecessary, as well as adrenaline auto-injector and venom immunotherapy prescription. The aim of this study was to prospectively evaluate the outcome of re-stings in a real-world setting, in patients with a history of one previous large local reaction. METHODS: We consecutively enrolled patients who experienced their first large local reaction (as per EAACI definition), treated with antihistamine and steroids. They were followed for field re-stings and assessed for risk of subsequent systemic reactions. RESULTS: We enrolled 662 patients. Out of the 225 re-stung subjects, 24% did not experience reactions, 52% reported a second large local reaction and 24% had systemic reactions. The risk of subsequent systemic reactions was higher in case of skin test reactivity to Apis mellifera or Vespula species (OR 2.1 and 3.8, respectively), in particular if positive at 0.001 µg/mL concentration (OR 13.4 and 16.5, respectively). CONCLUSIONS: Systemic reactions, after a previous large local reaction, occur more frequently than that reported by literature. After analysing the predictive role of large local reactions for systemic reactions, we demonstrated that an accurate diagnostic workup may be considered, particularly skin tests. Further studies in different countries are needed to confirm these results and large local reaction management.
BACKGROUND: Large local reaction to Hymenoptera stings is usually defined as a swelling >10 cm which lasts longer than 24 hours, sometimes associated with erythema, pruritus and blisters. Currently, the risk of subsequent systemic reactions after re-stings is considered low (2%-15%). Therefore, a diagnostic workup in case of large local reaction is often judged unnecessary, as well as adrenaline auto-injector and venom immunotherapy prescription. The aim of this study was to prospectively evaluate the outcome of re-stings in a real-world setting, in patients with a history of one previous large local reaction. METHODS: We consecutively enrolled patients who experienced their first large local reaction (as per EAACI definition), treated with antihistamine and steroids. They were followed for field re-stings and assessed for risk of subsequent systemic reactions. RESULTS: We enrolled 662 patients. Out of the 225 re-stung subjects, 24% did not experience reactions, 52% reported a second large local reaction and 24% had systemic reactions. The risk of subsequent systemic reactions was higher in case of skin test reactivity to Apis mellifera or Vespula species (OR 2.1 and 3.8, respectively), in particular if positive at 0.001 µg/mL concentration (OR 13.4 and 16.5, respectively). CONCLUSIONS: Systemic reactions, after a previous large local reaction, occur more frequently than that reported by literature. After analysing the predictive role of large local reactions for systemic reactions, we demonstrated that an accurate diagnostic workup may be considered, particularly skin tests. Further studies in different countries are needed to confirm these results and large local reaction management.
Authors: Iwona Poziomkowska-Gęsicka; Magdalena Kostrzewska; Michał Kurek Journal: Int J Environ Res Public Health Date: 2021-01-05 Impact factor: 3.390
Authors: Patrik Tripolt; Lisa Arzt-Gradwohl; Urban Čerpes; Karin Laipold; Barbara Binder; Gunter Johannes Sturm Journal: PLoS One Date: 2020-04-16 Impact factor: 3.240