Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
Ann Allergy Asthma Immunol. 2018 Aug;121(2):229-234.e1. doi: 10.1016/j.anai.2018.04.006. Epub 2018 Apr 12.
Venom-induced anaphylaxis (VIA) accounts for severe reactions. However, little is known about the short- and long-term management of VIA patients.
To assess the short- and long-term management of VIA.
Using a national anaphylaxis registry (C-CARE), we identified VIA cases presenting to emergency departments in Montreal and to emergency medical services (EMSs) in western Quebec over a 4-year period. Data were collected on clinical characteristics, triggers, and management. Consenting patients were contacted annually regarding long-term management. Univariate and multivariate logistic regressions were used to identify factors associated with epinephrine use, allergist assessment, and administration of immunotherapy.
Between June 2013 and May 2017, 115 VIA cases were identified. Epinephrine was administered to 63.5% (95% confidence interval [CI], 53.9%-72.1%) of all VIA cases by a health care professional. Treatment of reactions without epinephrine was more likely in reactions occurring at home and in nonsevere cases (no hypotension, hypoxia, or loss of consciousness). Among 48 patients who responded to a follow-up questionnaire, 95.8% (95% CI, 84.6%-99.3%) were prescribed epinephrine auto-injector, 68.8% (95% CI, 53.6%-80.9%) saw an allergist who confirmed the allergy in 63.6% of cases, and 81.0% of those with positive testing were administered immunotherapy. Among cases with follow-up, seeing an allergist was less likely in patients with known ischemic heart disease.
Almost 30% of patients with suspected VIA did not see an allergist, only two thirds of those seeing an allergist had allergy confirmation, and almost one fifth of those with confirmed allergy did not receive immunotherapy. Educational programs are needed to bridge this knowledge-to-action gap.
毒液引起的过敏反应（VIA）可导致严重反应。然而，对于 VIA 患者的短期和长期管理知之甚少。
评估 VIA 的短期和长期管理。
我们使用国家过敏症登记处（C-CARE），确定了在蒙特利尔的急诊室和魁北克西部的紧急医疗服务（EMS）中出现 VIA 的病例，时间跨度为 4 年。收集了临床特征、触发因素和管理方面的数据。对同意参加的患者每年进行长期管理方面的联系。使用单变量和多变量逻辑回归来确定与肾上腺素使用、过敏症评估和免疫疗法应用相关的因素。
在 2013 年 6 月至 2017 年 5 月期间，共确定了 115 例 VIA 病例。医护人员为 63.5%（95%置信区间[CI]，53.9%-72.1%）的所有 VIA 病例提供了肾上腺素。未使用肾上腺素治疗的反应更可能发生在家庭中且症状较轻（无低血压、缺氧或意识丧失）。在 48 名回复了随访问卷的患者中，95.8%（95% CI，84.6%-99.3%）被开了肾上腺素自动注射器，68.8%（95% CI，53.6%-80.9%）的患者看了过敏症专家，其中 63.6%的病例被确诊过敏，81.0%接受了阳性检测的患者接受了免疫治疗。在有随访的病例中，有已知缺血性心脏病的患者看过敏症专家的可能性较小。
大约 30%的疑似 VIA 患者没有看过敏症专家，只有三分之二的看过敏症专家的患者得到了过敏症的确诊，而且几乎五分之一的确诊过敏症的患者没有接受免疫治疗。需要开展教育计划以缩小这一知识与行动之间的差距。
