Analysis of Venom Hypersensitivity Reactions and Subsequent Preventative Management in VA Patient Population
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Priya J. Patel, MD, Alan H. Wolff, MD
Rationale: According to the latest practice parameter, referral to an allergist is appropriate for any patient who has had an allergic reaction to hymenoptera and is a potential candidate for immunotherapy. As a quality control measure, we determined whether physicians at our hospital followed this recommendation. We also looked to see if patients with systemic reactions had been prescribed epinephrine for self-administration. 

Methods: We searched our electronic medical records for all patients with a documented history of insect allergy. The type of reaction was determined to be systemic, local or unclear.  We also determined if epinephrine was prescribed, if there was a referral to an Allergist and whether venom immunotherapy was offered if indicated.    

Results: Of the 620 veterans with a documented insect allergy, about 61% had a systemic reaction, 6% had a local reaction and the rest of the descriptions were unclear.  Only 53% of those with a systemic reaction were prescribed epinephrine, although in 67% the prescription was expired. Allergy and Immunology consultation was obtained in 12% of those identified as having a systemic reaction. 

Conclusions: A surprisingly low percent of patients with systemic reactions to venom stings saw an Allergist and were prescribed self-injectable epinephrine. Also very few of these patients had active prescriptions for their epinephrine.  It is important to educate physicians to prescribe self-injectable epinephrine and refer to an Allergist when a systemic reaction to venom allergy is identified.