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The natural history and epidemiology of insect venom allergy: clinical implications.

机译：昆虫毒液过敏的自然历史和流行病学：临床意义。

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摘要

Hymenoptera stings can cause severe systemic allergic reactions and occasionally fatal anaphylaxis, which contribute significantly to morbidity and deterioration in health-related quality of life. The latest epidemiological data confirm the importance of insect sting allergy as a cause of anaphylaxis. Despite the high prevalence of asymptomatic sensitization, the prevalence of sting-induced systemic reactions (SRs) is low. However, to date, no parameter has been identified that can predict who will have a future reaction and whether it will be a large local reaction or anaphylactic. The combination of several concomitant factors, which include environmental, genetics and individual factors, may account for the occurrence of a system reaction in individual patients. Several not completely known factors may be associated with the severity of systemic re-stings. As about 50% of subjects with fatal sting reactions had no documented history of a previous SR, greater insight of the natural history and risk factors is required, especially in asymptomatic sensitized subjects. For patients with SRs, prevention of future severe allergic reactions starts with referral to an emergency department, correct administration of epinephrine by medical staff, referral to an allergist and coaching for the self-administration of epinephrine. However, most insect sting victims failed to seek medical advice and hospital attendance does not always correlate with the severity of the allergic reaction. Moreover, only about one-third of patients received a prescription for self-injectable epinephrine and were officially referred to an allergist after being discharged, causing the non- or delayed prescription of specific immunotherapy. Significantly, this means that at least half of the sting fatalities in patients with a positive history could have been avoided through the timely administration of specific immunotherapy. These findings indicate the urgent need to educate the general population and doctors on the management of venom-allergic patients.
机译：膜翅目刺伤会引起严重的全身性过敏反应，偶有致命的过敏反应，这极大地促进了发病率和与健康相关的生活质量下降。最新的流行病学数据证实了昆虫ing过敏是引起过敏反应的重要性。尽管无症状致敏的患病率很高，但刺痛引起的全身反应（SR）的患病率仍然很低。但是，迄今为止，还没有找到可以预测谁会发生未来反应以及是否会是局部局部反应或过敏反应的参数。几种伴随因素的组合，包括环境，遗传和个体因素，可以解释个体患者中系统反应的发生。几个尚不完全清楚的因素可能与全身缓解的严重程度有关。由于约有50％的具有致命性刺痛反应的受试者没有以前的SR病史记录，因此需要对自然病史和危险因素有更深入的了解，尤其是在无症状致敏受试者中。对于有SR的患者，要预防将来发生严重的过敏反应，首先要转诊至急诊科，由医务人员正确使用肾上腺素，转介给过敏症医生并指导肾上腺素的自我管理。但是，大多数昆虫刺伤的受害者未能寻求医疗建议，医院出诊并不总是与过敏反应的严重程度相关。此外，只有约三分之一的患者接受了可自我注射的肾上腺素的处方，出院后被正式转诊为过敏症患者，从而导致没有或延迟进行特异性免疫疗法的处方。重要的是，这意味着通过及时给予特异性免疫疗法可以避免病史呈阳性的患者中至少有一半的刺伤死亡。这些发现表明，迫切需要对普通人群和医生进行毒液过敏患者的管理教育。

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