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Current state of follow-up care for patients with Hymenoptera venom anaphylaxis in southwest Germany

Major impact of early information

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Abstract

Background

Up to 3.5 % of the population experience anaphylactic reactions in response to Hymenoptera stings. Current guidelines are in place for the diagnostic workup and follow-up care of patients with Hymenoptera venom anaphylaxis (HVA). However, little is known about the degree of implementation of the recommendations and patient attitudes toward the recommendations in the general patient population.

Methods

For the analysis of the follow-up care in real life, a retrospective questionnaire-based study was conducted in unselected patients who had received treatment from an emergency medical response team for HVA, as documented in records of three regional Medical Emergency Response Centers.

Results

From over 125,000 cases, a filtered list of 1,895 patients that coded for anaphylaxis was generated and examination of paper records identified 548 patients with a documented insect sting anaphylaxis. Patients were sent a standardized questionnaire addressing different aspects of diagnostics and follow-up care. Almost 40 % of the patients did not receive a referral to an allergist at the emergency center, over 50 % did not consult an allergy specialist at any time after the index sting, 25 % did not receive any form of diagnostic workup, over 30 % did not receive any information about venom immunotherapy (VIT) as treatment option and only 50 % were eventually started on VIT. Emergency medication was prescribed in 90 % of the cases, 77 % including an adrenalin auto injector, of which 47 % were expired at the time of the survey. Patients who were informed about diagnostic and treatment options early during the index event, i. e., during the stay in the emergency department, displayed a higher rate of referral to an allergist (70 % vs. 17 %), higher rate of diagnostic workup (88 % vs. 59 %), and a higher rate of initiation of VIT (89 % vs. 64 %), as compared to patients who did not.

Conclusion

Our results demonstrate that there are missed opportunities for secondary and tertiary prevention of anaphylaxis due to insect venom allergy and that early information on required diagnostics and treatment options has a major impact on the degree of proper follow-up care in line with current guideline recommendations.

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Abbreviations

BK:

Bad Krozingen

EAI:

Epinephrine auto-injectors

FR:

Freiburg

GP:

Göppingen

HVA:

Hymenoptera venom allergy

UKF:

Medical Center Freiburg

VIT:

Venom immunotherapy

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Authors and Affiliations

  1. Department of Dermatology, Allergy Research Group, Medical Center - University of Freiburg, Freiburg, Germany

    Manisha Manmohan, Sabine Müller &  Thilo Jakob

  2. Department of Dermatology and Allergology, University Medical Center Gießen Justus-Liebig University Gießen, Gaffky Strasse 14, 35392, Giessen, Germany

    Manisha Manmohan, Michèle Myriam Rauber &  Thilo Jakob

  3. Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, USA

    Manisha Manmohan

  4. Emergency Medical Response Center Freiburg, St. Joseph‘s Hospital, Freiburg, Germany

    Frank Koberne & H. Reisch

  5. Emergency Medical Response Center Bad Krozingen, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany

    Joachim Koster

  6. Department of Anaesthesia, Intensive Care and Emergency Medicine, Alb Fils Kliniken GmbH, Klinik am Eichert, Göppingen, Germany

    Richard Böhm, Martin Messelken & Matthias Fischer

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  1. Manisha Manmohan
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  2. Sabine Müller
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  9. Matthias Fischer
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  10. Thilo Jakob
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Correspondence to Thilo Jakob.

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Acknowledgements

We would like to thank Anne Rösberg for her help with screening emergency medical records, Christiane Iredi for her help in preparing the questionnaire mailings, and Britta Dorn for her help with the figures.

Conflict of interest

Thilo Jakob has received research support from ALK-Abello, Allergy Therapeutics, Allergopharma, Cosmetics Europe, Novartis; speakers honoraria and consulting fees from ALK, Allergy Therapeutics, Allergopharma, Leti, and Novartis. M. Manmohan, S. Müller, M. M. Rauber, F. Koberne, H. Reisch, J. Koster, R. Böhm, M. Messelken and M. Fischer declare that they have no competing interests.

Cite this as

Manmohan M, Müller S, Rauber MM, Koberne F, Reisch H, Koster J, Böhm R, Messelken M, Fischer M, Jakob T. Current state of follow-up care for patients with Hymenoptera venom anaphylaxis in southwest Germany — major impact of early information. Allergo J Int 2018; 27:4–14 https:/doi.org/10.1007/s40629-017-0046-7

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Manmohan, M., Müller, S., Rauber, M.M. et al. Current state of follow-up care for patients with Hymenoptera venom anaphylaxis in southwest Germany. Allergo J 27, 20–31 (2018). https://doi.org/10.1007/s15007-018-1523-0

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