18
Management
Î SS 40: Because of the risk of anaphylaxis, prescribe an AIE for all
patients receiving omalizumab and instruct patients in its use. Advised
them to carry it before and 24 hours after their omalizumab injection.
(S-D)
Î SS 41: Consider skin testing for patients who have developed
anaphylaxis from biologic agents. If patients have developed
anaphylaxis to biologic agents and no therapeutic alternative exists,
consider rapid desensitization to induce temporary tolerance,
recognizing that repeat desensitizations might be necessary
depending on the interval between infusions. (S-C)
Î SS 42: Use a lower osmolality RCM and premedicate patients with
prednisone and diphenhydramine if the patient has a history of
anaphylactoid reactions to RCM. (S-D)
V. Insect Sting Anaphylaxis
Î SS 43: Do not generally perform in vitro or skin tests for specific IgE
antibodies to venom or start venom immunotherapy (VIT) in patients
who have large local reactions and in children with mild (cutaneous)
systemic reactions (SRs), because the chance of an SR to a sting is low
(5-10%). These groups do not generally require venom testing or VIT.
(S-A)
Î SS 44: Consider obtaining a baseline serum tryptase level to rule out
mastocytosis in patients with suspected anaphylactic reactions to
stings. (S-A)
Î SS 45: If patients need to be evaluated for stinging insect
hypersensitivity, perform a venom skin test because it is the most
sensitive diagnostic test, although in vitro testing is an important
complementary test. (S-A)
Î SS 46: Do NOT rely on the degree of sensitivity on skin or in vitro
testing because it does not reliably predict the severity of a sting
reaction. (R-B)
Î SS 47: Recognize that a diagnosis cannot be made on skin or serum
testing alone and the history is essential, because asymptomatic
venom sensitization can be detected in ≤25% of adults. (S-B)
Î SS 48: Recommend VIT for patients with systemic sensitivity to
stinging insects because this treatment is highly (80%-98%) effective.
(S-A)
Î SS 49: Diagnose and treat allergy to fire ant stings with whole-
body extracts, which provide adequate allergen concentrations for
reasonable efficacy. (R-B)
