• Franziska Ruëff, Bernhard Przybilla, Maria Beatrice Biló, Ulrich Müller, Fabian Scheipl, Werner Aberer, Joëlle Birnbaum, Anna Bodzenta-Lukaszyk, Floriano Bonifazi, Christoph Bucher, Paolo Campi, Ulf Darsow, Cornelia Egger, Gabrielle Haeberli, Thomas Hawranek, Michael Körner, Iwona Kucharewicz, Helmut Küchenhoff, Roland Lang, Oliviero Quercia, Norbert Reider, Maurizio Severino, Michael Sticherling, Gunter Johannes Sturm, and Brunello Wüthrich.
• Department of Dermatology and Allergology, Ludwig-Maximilians-Universität, Munich, Germany. Franziska.Rueff@med.uni-muenchen.de
• J. Allergy Clin. Immunol. 2009 Nov 1; 124 (5): 1047-54.

BackgroundSevere anaphylaxis to honeybee or vespid stings is associated with a variety of risk factors, which are poorly defined.ObjectiveOur aim was to evaluate the association of baseline serum tryptase concentrations and other variables routinely recorded during patient evaluation with the frequency of past severe anaphylaxis after a field sting.MethodsIn this observational multicenter study, we enrolled 962 patients with established bee or vespid venom allergy who had a systemic reaction after a field sting. Data were collected on tryptase concentration, age, sex, culprit insect, cardiovascular medication, and the number of preceding minor systemic reactions before the index field sting. A severe reaction was defined as anaphylactic shock, loss of consciousness, or cardiopulmonary arrest. The index sting was defined as the hitherto first, most severe systemic field-sting reaction. Relative rates were calculated with generalized additive models.ResultsTwo hundred six (21.4%) patients had a severe anaphylactic reaction after a field sting. The frequency of this event increased significantly with higher tryptase concentrations (nonlinear association). Other factors significantly associated with severe reactions after a field sting were vespid venom allergy, older age, male sex, angiotensin-converting enzyme inhibitor medication, and 1 or more preceding field stings with a less severe systemic reaction.ConclusionIn patients with honeybee or vespid venom allergy, baseline serum tryptase concentrations are associated with the risk for severe anaphylactic reactions. Preventive measures should include substitution of angiotensin-converting enzyme inhibitors.

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