Hymenoptera venom allergy MUDr. Mojmír Račanský

Dept. Of Allergology and Clinical Immunology FNOL Dept. Of Immunology LF UPOL

• Order Hymenoptera

• Apidae = honey bee, bumblebee

• Vespidae = hornet, wasp/yellow jacket

• Formicidae = ants

Hymenoptera venom allergy

JED BLANOKŘÍDLÉHO HMYZU

• Personal history • Skin PRICK test with reduced allergen dose • Specific IgE antibodies and recombinant antibodies

DIAGNOSTIC PROCESS

HYMENOPTERA ALLERGY

• Normal reaction after insect sting • Developing in area of insect attack in seconds/few minutes • Painful annular efflorescence, 2 cm in diameter at maximum • Disappear spontaneously until 2 days

• Large local reaction • Itchy and painful efflorescence with swelling, redness and hotness • Up to 10 cm in diameter • Usually stays longer than 2 days • Large local reaction is not marker of higher risk of systemic reaction – only 5-

10% of patients with previous large local reaction developed systemic reaction

HYMENOPTERA ALLERGY

Therapy: per os 2nd generation antihistamines+

glucocorticoids

Standard emergency set: PREDNISON 20mg 2 tbl + CEZERA

5mg 2 tbl.

• Developing in app. 3% of main population

SYSTEMIC REACTION AFTER HYMENOPTERA STING

SEVERITY OF SYSTEMIC REACTION

Severity defined by affected organ system Clinical signs

1 Mild Dermis and epidermis Generalised urticaria, pruritus

2 Intermediate

Signs of impairment: breathing, cardiovascular system, gastrointestinal system

Dyspnoe, stridor, wheezing, nauzea, vomit, stomach ache, precolapse, chest pain

3 Severe Hypoxia, hypotension, unconsciousness, coma

Cyanosis or SpO2< 92%, Hypotension (SBP < 90 torr in adults), confusion, colaps, …

• THERAPY

ANAPHYLACTIC REACTION

EPINEPHRINE Way of administration: intramusclar Concentration: 1 mg/ml Dose: 0.01 mg/kg in maximal single dose of 0,5mg (=0.5 ml) Interval till next application: 5 minutes Autoinjectors: children to 25kg - 0.15mg for adults and children up to 30kg - 0.3mg

ANAPHYLACTIC REACTION

2. Intravenous administration of medication is necessary • Antihistamines

• i.v. – bisulepine (Dithiaden®) • p.o. – 2. generation (levocetirisine (Zyrtec®), desloratadine

(Aerius®), bilastine (Xados®) • Corticosteroids

• i.v. – hydrocortison 200mg, methylprednison 40mg in single dose • Oxygenoterapy – O2 6-8l/min • Administration of bronchodilatans

• inhaled β2-mimetics – salbutamol (Ventolin®), or in combiantion with parasympatolytcs= salbutamol+ipratropium (Berodual®)

• syntophyllin i.v. – 5 mg/kg

http://www.waojournal.org/content/4/2/13/figure/F5?highres=y

ANAPHYLACTIC REACTION

• Causal therapy of Hymenoptera allergy

• Podstatou alergenové imunoterapie je podávání zvyšujících se dávek přesně definovaného alergenu, kdy dochází k postupnému rozvoji dlouhodobé imunologické tolerance.

• Vysoká efektivita- 95% léčených po dosažení udržovací dávky efektivně chráněno při příštím pobodání

ALLERGEN SPECIFIC IMMUNOTHERAPY

Thank you for your attention!