Short and long-term management of cases of venom induced anaphylaxis (via) is suboptimal

Publication date: Available online 12 April 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Ashley Tritt, Sofianne Gabrielli, Sarah Zahabi, Ann Clarke, Jocelyn Moisan, Harley Eisman, Judy Morris, Lea Restivo, Greg Shand, Moshe Ben-Shoshan
BACKGROUNDVenom induced anaphylaxis (VIA) accounts for severe reactions. However, little is known about the short and long-term management of VIA cases.OBJECTIVETo assess the short and long-term management of VIA.METHODSUsing a national anaphylaxis registry (C-CARE), we identified VIA cases presenting to EDs in Montreal and to emergency medical services(EMS) in Western Quebec over a four-year period. Data were collected on clinical characteristics, triggers, and management. Consenting patients were contacted annually regarding long-term management. Univariate and multivariate logistic regression were used to identify factors associated with epinephrine use, allergist assessment, and administration of immunotherapy.RESULTSBetween June 2013 and May 2017, 115 VIA cases were identified. Epinephrine was administered to 63.5% (95%CI 53.9, 72.1%) of all VIA cases by a healthcare professional. Treatment of reactions without epinephrine was more likely in reactions occurring at home and in non-severe cases (no hypotension, hypoxia or loss of consciousness). Among 48 patients who responded to a follow-up questionnaire, 95.8% (95%CI, 84.6%, 99.3%) were prescribed epinephrine auto-injector, 68.8% (95%CI, 53.6%, 80.9%) saw an allergist who confirmed the allergy in 63.6% of cases, and 81.0% of those with positive testing were administered immunotherapy. Among cases with follow-up, seeing an allergist was less likely in patients with known ischemic heart disease.CONCLUSIONAlmost 30% of patients with suspected VIA did not see an allergist, only two thirds of those seeing an allergist had allergy confirmation, and almost one fifth of those with confirmed allergy did not receive immunotherapy. Educational programs are required to bridge this knowledge-to-action gap.



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