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

Francuzik W, Ruëff F, Bauer A, Bilò MB, Cardona V, Christoff G, Dölle-Bierke S, Ensina L, Fernandes-Rivas M, Hawranek T, O'B Hourihane J, Jakob T, Papadopoulus NG, Pföhler C, Poziomkowska-Gęsicka I, Van der Brempt X, Hofmeier KS, Treudler R, Wagner N, Wedi B, Worm M (2020)

Publication Type: Journal article

Publication year: 2020

Journal

DOI: 10.1016/j.jaci.2020.06.008

Abstract

BACKGROUND: Venom-induced anaphylaxis is a common, potentially life-threatening hypersensitivity reaction associated with specific: 1) symptom profile, 2) cofactors, and 3) management. Identifying the differences in phenotypes of anaphylaxis is crucial for future management guidelines and the development of a personalized medicine approach. OBJECTIVE: This study aimed to evaluate the phenotype and risk factors of venom-induced anaphylaxis. METHODS: Using data from the European Anaphylaxis Registry (12874 cases) we identified 3612 patients with venom-induced anaphylaxis and analyzed these in comparison to sex- and age- matched anaphylaxis cases triggered by other elicitors (non-VIA n = 3605). RESULTS: Venom-induced anaphylaxis more frequently involved more than three organ systems and was associated with cardiovascular symptoms. The absence of skin symptoms during anaphylaxis correlated with baseline serum tryptase and was associated with an increased risk of a severe reaction. Intramuscular or intravenous epinephrine was administered significantly less often in venom-induced anaphylaxis, in particular in patients without prior history of anaphylaxis. Baseline serum tryptase 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 higher risk of severe VIA. Patients receiving beta-blockers or ACE-I had a higher risk of developing severe cardiovascular symptoms (including cardiac arrest) in VIA and non-VIA cases. Patients undergoing VIA received epinephrine less frequently than non-VIA cases.

Involved external institutions

Medical University Sofia / Медицински университет Bulgaria (BG) Pomeranian Medical University / Pomorski Uniwersytet Medyczny w Szczecinie (PMU) Poland (PL) Federal University of São Paulo / Universidade Federal de São Paulo (UNIFESP) Brazil (BR) Charité - Universitätsmedizin Berlin Germany (DE) Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona Italy (IT) National and Kapodistrian University of Athens Greece (GR) Ludwig-Maximilians-Universität (LMU) Germany (DE) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) University College Cork (UCC) Ireland (IE) Universidad Complutense de Madrid (UCM) Spain (ES) Universitätsklinikum Leipzig Germany (DE) Vall d'Hebron University Hospital / Hospital Universitari Vall d'Hebron Spain (ES) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Universitätsklinikum des Saarlandes (UKS) Germany (DE) Universitätsklinikum Freiburg Germany (DE) Universitätsspital Basel Switzerland (CH)

How to cite

APA:

Francuzik, W., Ruëff, F., Bauer, A., Bilò, M.B., Cardona, V., Christoff, G.,... 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. https://doi.org/10.1016/j.jaci.2020.06.008

MLA:

Francuzik, Wojciech, et al. "Phenotype and risk factors of venom-induced anaphylaxis: a case-control study of the European Anaphylaxis Registry." Journal of Allergy and Clinical Immunology (2020).

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