HYMENOPTERA VENOM-INDUCED ANAPHYLAXİS: OUR CLİNİCAL EXPERİENCE

Year 2023, , 562 - 571, 23.09.2023

Nurullah Yekta Akçam , Ayşe Kırmızıtaş Aydoğdu

https://doi.org/10.17343/sdutfd.1348270

Abstract

Objective
Venom allergies are the most common cause of
anaphylaxis in adults and are characterized by severe
anaphylaxis. We aim to investigate the relationship
rebetween
the bee species causing the reaction and the
severity of anaphylaxis, in-vivo and in-vitro test results
and demographic characteristics of the cases in adult
patients who were treated in the allergy clinic for bee
venom-related anaphylaxis.
Material and Method
Patients who developed systemic reaction due to bee
venom allergy in the adult allergy clinic between March
2017 and June 2022 meeting the National Institutes
of Allergy and Infectious Disease (NIAID) and Food
Allergy and Anaphylaxis Network (FAAN) anaphylaxis
criteria were included in the study. Demographic and
clinical data (tryptase, total IgE, bee venom specific
IgE levels and skin test) of all cases were evaluated.
Anaphylaxis severity was scored according to the Mueller
criteria. Adrenaline use in attacks and carrying
an adrenaline auto-injector were evaluated.
Results
Among 102 cases, 53.9% were men and mean age
was 44.80 years. It was determined that anaphylaxis
developed with honeybee in 69.60%, wasps in
19.6%, and both species in 10.8%. The severity of
anaphylaxis, according to Mueller classification were
as follows: 10.7% Grade-I, 58.8% Grade-II, 27.45%
Grade-III and Grade-IV 2.91%. In terms of attack
frequency, it was determined that 20 patients had a
single attack; 37 patients had 2 and 42 patients had
3 or more anaphylaxis attacks. Atopy was detected in
44.11% of the patients. No significant correlation was
found between age, gender, atopic status, chronic
disease coexistence, additional drug use, eosinophil
levels, TIgE levels and the severity of the reaction.
Although 80.4% of the patients were prescribed an
adrenaline autoinjector, the rate of its usage in the treatment
of attacks was 31.4%.
Conclusion
Most of the patients suffering from bee venom-induced
anaphylaxis had a history of more than one attack.
The rates of adrenaline use in emergency treatment
still remain at low levels. In our study, honeybees are
the most responsible type of bee; the males appear to
be at a greater risk as compared to females.

Keywords

Anaphylaxis, epinephrine, risk factors, bee venom allergy

ARI VENOMUNA BAĞLI ANAFİLAKSİ: KLİNİK DENEYİMİMİZ

Abstract

Amaç
Arı alerjileri en sık anafilaksi nedenlerindendir ve
şiddetli anafilaksi ile karakterizedir. Amacımız arı venomuna
bağlı anafilaksi geçiren erişkin olgularda reaksiyona
yol açan arı türleri ile gelişen anafilaksinin
şiddeti, in-vivo ve in-vitro test sonuçları ile olguların
demografik özelliklerini araştırmaktır.
Gereç ve Yöntem
Mart 2017- Haziran 2022 tarihleri arasında kliniğimizde
arı alerjisine bağlı sistemik reaksiyon nedeniyle
takipli ve Amerikan Ulusal Alerji ve Enfeksiyon Hastalıkları
Enstitüsü (National Institutes of Allergy and Infectious
Disease, NIAID) ile Besin Alerjileri ve Anafilaksi
Ağı (Food Allergy and Anaphylaxis Network, FAAN)
tarafından 2006 yılında geliştirilen ölçütlere göre anafilaksi
kriterlerine uyan olgular alındı. Arı türü, bazal
triptaz, Total IgE ve venom spesifik IgE düzeyleri, deri
testi sonuçları kaydedildi. Anafilaksi şiddeti Mueller kriterlerine
göre skorlandı. Ataklarda adrenalin kullanımı,
adrenalin otoenjektörü bulundurma değerlendirildi.
Bulgular
Toplam 102 arı ilişkili anafilaksi olgusundan %53,9’unun
erkek olup ortalama yaşın 44.8 olduğu saptandı. Arı
türü açısından %69,6 olguda bal arısı (Apidae), %19,6
olguda yaban arısı (Vespidae), %10,8 olguda ise her
iki türle anafilaksi geliştiği belirlendi. Anafilaksi şiddeti
Mueller sınıflanmasına göre %10,7 olgu Grade I,
%58,8 Grade II, %27,45 Grade III, %2,91 ise Grade IV
ile uyumluydu. Atak sıklığı açısından 20 olgu tek atak,
37 olgu 2, 42 olgu ise 3 veya daha fazla anafilaksi
atağı geçirdiği belirlendi. Hastaların %44,11’inde atopi
saptandı. Yaş, cinsiyet, atopik durum, kronik hastalık
birlikteliği, ek ilaç kullanımı ve kanda eosinofil, total
IgE düzeyleri ile reaksiyon şiddeti arasında anlamlı bir
ilişki saptanmadı. Hastaların %80,4’üne adrenalin otoenjektör
reçetelenmesine rağmen tedavide adrenalin
kullanım oranı %31,4 saptandı.
Sonuç
Arı venom ilişkili anafilakside olguların çoğu birden
fazla atak geçirmesine rağmen tedavide adrenalin kullanım
oranları düşük seviyelerde kalmaktadır. En sık
anafilaksi bal arısı sokmasına bağlı olarak gelişirken
erkek cinsiyette riskin daha fazla olduğu saptandı

Keywords

Anafilaksi, epinefrin, risk faktörleri, arı venom alerjisi

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