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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2017

Open Access 01-12-2017 | Original research

Pre-hospital treatment of bee and wasp induced anaphylactic reactions: a retrospective study

Authors: Athamaica Ruiz Oropeza, Søren Mikkelsen, Carsten Bindslev-Jensen, Charlotte G. Mortz

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2017

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Abstract

Background

Bee and wasp stings are among the most common triggers of anaphylaxis in adults representing around 20% of fatal anaphylaxis from any cause. Data of pre-hospital treatment of bee and wasp induced anaphylactic reactions are sparse. This study aimed to estimate the incidence of bee and wasp induced anaphylactic reactions, the severity of the reactions and to correlate the pre-hospital treatment with the severity of the anaphylactic reaction.

Methods

Retrospective and descriptive study based on data from the Mobile Emergency Care Units (MECUs) in the Region of Southern Denmark (2008 only for Odense and 2009–2014 for the whole region). Discharge summaries with diagnosis related to anaphylaxis according to the International Classification of Diseases 10 (ICD-10) were reviewed to identify bee and wasp induced anaphylactic reactions. The severity of the anaphylactic reaction was assessed according to Sampson’s severity score and Mueller’s severity score. Treatment was evaluated in relation to administration of adrenaline, glucocorticoids and antihistamine.

Results

We identified 273 cases (Odense 2008 n = 14 and Region of Southern Denmark 2009–2014 n = 259) of bee and wasp induced anaphylaxis. The Incidence Rate was estimated to 35.8 cases per 1,000,000 person year (95% CI 25.9–48.2) in the Region of Southern Denmark during 2009–2014. According to Sampson’s severity score, 65% (n = 177) of the cases were graded as moderate to severe anaphylaxis (grade 3–5). Almost one third of cases could not be graded according to Mueller’s severity score. Adrenaline was administrated in 54% (96/177) of cases with moderate to severe anaphylaxis according to Sampson’s severity score, compared to 88% receiving intravenous glucocorticoids (p < 0.001) and 91% receiving intravenous antihistamines (p < 0.001). Even in severe anaphylaxis (grade 5) adrenaline was administered in only 80% of the cases.

Conclusion

Treatment with adrenaline is not administered in accordance with international guidelines. However, making an assessment of the severity of the anaphylactic reaction is difficult in retrospective studies.
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Metadata
Title
Pre-hospital treatment of bee and wasp induced anaphylactic reactions: a retrospective study
Authors
Athamaica Ruiz Oropeza
Søren Mikkelsen
Carsten Bindslev-Jensen
Charlotte G. Mortz
Publication date
01-12-2017
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-016-0344-y

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