ÎAll patients receiving omalizumab should be prescribed an automatic epinephrine injector and instructed in its use. The physician should ensure that the patient has such an injector with them at the time of the visits to the office for injection. (D)
ÎA pre-assessment (before the injection of omalizumab) of the patient's current health status should be made. This should include vital signs, an assessment of asthma control, and measurement of lung function. (D)
Stinging Insect Hypersensitivity
ÎAnaphylaxis to insect stings has occurred in 3% of adults and 1% of children who have been stung; they can be fatal even on the first reaction. (B)
ÎCutaneous systemic reactions are most common in children, hypotensive shock is most common in adults, and respiratory manifestations occur equally in all age groups. (B)
ÎThe chance of a systemic reaction to a sting is low (5-10%) in patients who have large local reactions and in children with mild (cutaneous) systemic reactions. (A)
ÎVenom skin tests are most sensitive for diagnosis but an important complementary test. (A)
testing is
ÎThe degree of sensitivity to skin or in vitro tests does not reliably predict the severity of a sting reaction. (B)
ÎSince asymptomatic venom sensitization can be detected in up to 25% of adults, diagnosis cannot be made on skin testing alone; the history is essential. (C)
ÎPatients discharged from emergency care of anaphylaxis should be given or prescribed auto-injectible epinephrine and receive instruction in its proper use and indications for use, as well as advised to set up an appointment with an allergist-immunologist. Patients should understand, however, that using auto-injectible epinephrine is not a substitute for emergency medical attention. (A)
ÎVenom immunotherapy (VIT) should be recommended for patients with systemic sensitivity to stinging insects since this treatment is highly (90% to 98%) effective. (B)
ÎMost patients can discontinue VIT after 5 years, with low residual risk of a severe sting reaction. (A)
ÎThere is a need to develop tests that are:
> markers of susceptibility that can serve as a screening test to identify patients at high risk of sting anaphylaxis; and
> markers of tolerance induction to identify patients who can safely discontinue venom immunotherapy. (D)
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