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JACI Highlights - November 2009
Tryptase predicts risk for severe anaphylaxis after insect stings
Severe anaphylaxis to honey bee or vespid stings is associated with a variety of risk factors. Ruëff et al evaluated the association of baseline serum tryptase concentration and of other variables with past severe anaphylaxis after a field sting. In an observational multicentre study, the authors enrolled 962 patients with established bee or vespid venom allergy who had developed a systemic reaction after a field sting. Data were collected on tryptase concentration, age, sex, culprit insect, cardiovascular medication, and the number of preceding minor systemic reactions. A severe reaction was defined as anaphylactic shock, loss of consciousness, or cardiopulmonary arrest. In all, 206 patients (21.4%) had a severe anaphylactic reaction after a field sting. The frequency of this event increased significantly with higher tryptase concentrations. Also important, the authors found that severe allergic reactions occurred more often in older patients, in males, in those with a history of 1 or more previous less severe systemic reactions, in patients allergic to wasps, and in those taking ACE inhibitors. Measurement of baseline tryptase concentration might be helpful for risk prediction and for decisions on which patients should be offered immunotherapy. Preventive measures should include substitution of ACE inhibitors in patients with previous anaphylactic sting reactions.
“Predictors of severe systemic anaphylactic reactions in Hymenoptera venom allergy: the importance of baseline serum tryptase” by Rueff et al. (JACI November 2009 Volume 124 No. 5)
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