@article{3003261,
    title = "Phenotype and risk factors of venom-induced anaphylaxis: A case-control study of the European Anaphylaxis Registry",
    author = "Francuzik, W. and Ruëff, F. and Bauer, A. and Bilò, M.B. and Cardona, V. and Christoff, G. and Dölle-Bierke, S. and Ensina, L. and Fernández Rivas, M. and Hawranek, T. and O'B Hourihane, J. and Jakob, T. and Papadopoulos, N.G. and Pföhler, C. and Poziomkowska-Gęsicka, I. and Van der Brempt, X. and Scherer Hofmeier, K. and Treudler, R. and Wagner, N. and Wedi, B. and Worm, M.",
    journal = "Allergy: European Journal of Allergy and Clinical Immunology",
    year = "2021",
    volume = "147",
    number = "2",
    pages = "653-662.e9",
    publisher = "Mosby Year Book Inc",
    doi = "10.1016/j.jaci.2020.06.008",
    keywords = "antihistaminic agent;  beta adrenergic receptor blocking agent;  corticosteroid;  dipeptidyl carboxypeptidase inhibitor;  epinephrine;  insect venom;  tryptase;  arthropod venom, adult;  age;  anaphylaxis;  Article;  cardiovascular symptom;  case control study;  cohort analysis;  controlled study;  disease severity;  female;  high risk patient;  human;  major clinical study;  male;  personalized medicine;  phenotype;  priority journal;  protein blood level;  register;  risk factor;  sex;  skin manifestation;  venom induced anaphylaxis;  anaphylaxis;  child;  complication;  Europe;  insect bite;  pathophysiology;  phenotype;  risk factor, Adult;  Anaphylaxis;  Arthropod Venoms;  Case-Control Studies;  Child;  Cohort Studies;  Europe;  Female;  Humans;  Insect Bites and Stings;  Male;  Phenotype;  Registries;  Risk Factors",
    abstract = "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. © 2020 American Academy of Allergy, Asthma & Immunology"
}