Hymenoptera Venom-Induced Anaphylaxis in Acute Care Settings

Rationale: Anaphylaxis is a severe, potentially life-threatening allergic reaction. Venom-induced anaphylaxis can be especially dangerous, and patients are typically seen in acute care settings when systemic reactions occur. Elevated tryptase levels can be used to support the diagnosis of anaphylaxis when obtained within a few hours of symptom onset. For patients with venom allergy, immunotherapy significantly decreases the risk of recurrent systemic reactions. Studies examining physician recognition and management of anaphylaxis due to hymenoptera venom are underrepresented in the primary literature.

Methods: An electronic case-based survey describing a child experiencing venom-induced anaphylaxis was completed by physicians in acute care settings.

Results: There were 45 total participants, with backgrounds in emergency medicine, urgent care, and primary care.  20% (9/45 physicians) elected not to treat with epinephrine and 24.4% (11/45) did not refer the child to an allergist. Of the 36 physicians (80%) who treated with epinephrine, 13.9% (5/36) responded that the patient was either not experiencing anaphylaxis or they were unsure. Less than 1% of physicians (3/45) elected to obtain a tryptase level.  While 75.6% (34/45) of responders referred the patient to allergy, 57.8% (26/45) did not know the patient should start venom immunotherapy despite positive testing confirming hymenoptera allergy.

Conclusions: There is a need for additional education regarding recognition and treatment of anaphylaxis induced by hymenoptera venom, which can be particularly life-threatening. Moreover, increased awareness of the utility of tryptase levels in the acute setting and the indications for venom immunotherapy is critical for the proper care of patients with hymenoptera-induced anaphylaxis.