Background

Venom-induced anaphylaxis (VIA) is a common, potentially life-threatening hypersensitivity reaction associated with (1) a specific symptom profile, 2) specific cofactors, and 3) specific management. Identifying the differences in phenotypes of anaphylaxis is crucial for future management guidelines and development of a personalized medicine approach.

Objective

This study aimed to evaluate the phenotype and risk factors of VIA.

Methods

Using data from the European Anaphylaxis Registry (12,874 cases), we identified 3,612 patients with VIA and analyzed their cases in comparison with sex- and age-matched anaphylaxis cases triggered by other elicitors (non-VIA cases [n = 3,605]).

Results

VIA more frequently involved more than 3 organ systems and was associated with cardiovascular symptoms. The absence of skin symptoms during anaphylaxis was correlated with baseline serum tryptase level and was associated with an increased risk of a severe reaction. Intramuscular or intravenous epinephrine was administered significantly less often in VIA, in particular, in patients without a history of anaphylaxis. A baseline serum tryptase level within the upper normal range (8-11.5 ng/mL) was more frequently associated with severe anaphylaxis.

Conclusion

Using a large cohort of VIA cases, we have validated that patients with intermediate baseline serum tryptase levels (8-11 ng/mL) and without skin involvement have a higher risk of severe VIA. Patients receiving β-blockers or angiotensin-converting enzyme inhibitors had a higher risk of developing severe cardiovascular symptoms (including cardiac arrest) in VIA and non-VIA cases. Patients experiencing VIA received epinephrine less frequently than did cases with non-VIA.

中文翻译：

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毒液引起的过敏反应的表型和危险因素：欧洲过敏反应登记处的病例对照研究

背景

毒液诱发的过敏反应 (VIA) 是一种常见的、可能危及生命的超敏反应，与 (1) 特定症状特征、2) 特定辅助因素和 3) 特定管理相关。确定过敏反应表型的差异对于未来的管理指南和个性化医疗方法的开发至关重要。

客观的

本研究旨在评估 VIA 的表型和危险因素。

方法

使用来自欧洲过敏反应登记处的数据（12,874 例），我们确定了 3,612 名 VIA 患者，并与由其他诱发因素触发的性别和年龄匹配的过敏反应病例（非 VIA 病例 [n = 3,605]）进行了比较分析。

结果

VIA 更频繁地涉及 3 个以上的器官系统，并与心血管症状有关。过敏反应期间没有皮肤症状与基线血清类胰蛋白酶水平相关，并与严重反应风险增加相关。在 VIA 中，肌肉注射或静脉注射肾上腺素的频率明显降低，特别是在没有过敏反应史的患者中。处于正常上限 (8-11.5 ng/mL) 的基线血清类胰蛋白酶水平更常与严重过敏反应相关。

结论

使用大量 VIA 病例队列，我们​​已经证实，具有中等基线血清类胰蛋白酶水平 (8-11 ng/mL) 且没有皮肤受累的患者发生严重 VIA 的风险更高。接受 β 受体阻滞剂或血管紧张素转换酶抑制剂的患者在 VIA 和非 VIA 病例中出现严重心血管症状（包括心脏骤停）的风险更高。经历 VIA 的患者接受肾上腺素的频率低于非 VIA 的患者。