ARI VENOMUNA BAĞLI ANAFİLAKSİ: KLİNİK DENEYİMİMİZ

Öz

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

Anahtar Kelimeler

• Anafilaksi
• epinefrin
• risk faktörleri
• arı venom alerjisi

HYMENOPTERA VENOM-INDUCED ANAPHYLAXİS: OUR CLİNİCAL EXPERİENCE

Öz

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.

Anahtar Kelimeler

• Anaphylaxis
• epinephrine
• risk factors
• bee venom allergy

Kaynakça

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