Prescription of Adrenaline Injector to Outdoor Workers Who Had Experienced an Anaphylactic Reaction after a Hymenoptera Sting in Japan

Rationale: Forestry and field workers who work outdoors are at high risk of Hymenoptera stings and may develop occupation-related allergies after being stung. We reported that approximately 40% of these workers had specific IgE to Hymenoptera venom. However, clinical surveys of Hymenoptera stings in the occupational setting and prescription of adrenaline injector to affected workers have rarely been reported. We surveyed outdoor workers in Japan who had experienced an anaphylactic reaction after a Hymenoptera sting to examine the rate of prescription of adrenaline injectors.

Methods: Questionnaires on Hymenoptera stings were completed by 1353 male forestry and field workers, and 365 (231 men, 134 women) office workers who acted as controls between July and November 2009. Among the participants, 294 had experienced anaphylaxis after a Hymenoptera sting.

Results: Among the subjects, 184, 25, 24, and 61 had experienced anaphylaxis of Mueller grade 1, 2, 3, and 4, respectively. Toxic systemic reactions due to multiple Hymenoptera stings were excluded from the analysis. A prescription of an adrenaline injector was given to only 45 (24%) subjects who had experienced grade 1 anaphylaxis, 7 (28%) who had grade 2, 2 (8%) who had grade 3, and 16 (26%) who had grade 4. These results indicate that a prescription of adrenaline injector was given to only 20% of subjects who had experienced an anaphylactic reaction after a Hymenoptera sting in Japan.

Conclusions: Adrenaline injectors should be prescribed to Japanese forestry and field workers who work outdoors and have experienced anaphylaxis due to a Hymenoptera sting.