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

Publication date: August 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 2

Author(s): Ashley Tritt, Sofianne Gabrielli, Sarah Zahabi, Ann Clarke, Jocelyn Moisan, Harley Eisman, Judy Morris, Lea Restivo, Greg Shand, Moshe Ben-Shoshan

Abstract

Background

Venom-induced anaphylaxis (VIA) accounts for severe reactions. However, little is known about the short- and long-term management of VIA patients.

Objective

To assess the short- and long-term management of VIA.

Methods

Using a national anaphylaxis registry (C-CARE), we identified VIA cases presenting to emergency departments in Montreal and to emergency medical services (EMSs) in western Quebec over a 4-year period. Data were collected on clinical characteristics, triggers, and management. Consenting patients were contacted annually regarding long-term management. Univariate and multivariate logistic regressions were used to identify factors associated with epinephrine use, allergist assessment, and administration of immunotherapy.

Results

Between June 2013 and May 2017, 115 VIA cases were identified. Epinephrine was administered to 63.5% (95% confidence interval [CI], 53.9%–72.1%) of all VIA cases by a health care professional. Treatment of reactions without epinephrine was more likely in reactions occurring at home and in nonsevere 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.

Conclusion

Almost 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 needed to bridge this knowledge-to-action gap.

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