Honey Bee Venom Re-Challenge During Specific Immunotherapy: Prolonged Cardio-Pulmonary Resuscitation Allowed Survival in a Case of Near Fatal Anaphylaxis

BACKGROUND Specific immunotherapy for patients with honey bee hypersensitivity is commonly applied. Re-challenge with venom is performed to prove protection.CASE PRESENATION We report a case of near fatal anaphylaxis with asystolia for 24 minutes in a 35-years-old patient with mastocytosis after honey bee sting challenge despite 5-years of specific immunotherapy. Successful cardio-pulmonary resuscitation (CPR) was applied for 32 minutes.CONCLUSION This intervention demonstrates, that in anaphylaxis with cardio-vascular arrest prolonged CPR for up to 40 minutes might be appropriate to overcome half time span of massively released histamine. Failure of specific immunotherapy was possibly due to sensitization to the allergen Api m10, probably underrepresented in commercial honey bee venom extracts. Also, molecular analyses might alert to potential unsuccessful outcome of venom specific immunotherapy especially in high-risk patients such as mastocytosis.

Incidence of Fatal Anaphylaxis: A Systematic Review of Observational Studies

Background: Fatal anaphylaxis is very rare, with an incidence ranging from 0.5 to 1 deaths per million person-years. Objective: Based on a systematic review, we aimed to explain differences in the reported incidence of fatal anaphylaxis based on the methodological and demographic factors addressed in the various studies. Methods: We searched PubMed/MEDLINE, EMBASE, and the Web of Science for relevant retrospective and prospective cohort studies and registry studies that had assessed the anaphylaxis death rate for the population of a country or for an administrative region. The research strategy was based on combining “anaphylaxis” with “death”, “study design”, and “main outcomes” (incidence). Results: A total of 46 studies met the study criteria and included 16,541 deaths. The range of the anaphylaxis mortality rate for all causes of anaphylaxis was 0.002-2.51 deaths per million person-years. Fatal anaphylaxis due to food (range 0.002-0.29) was rarer than deaths due to drugs (range 0.004-0.56) or Hymenoptera venom (range 0.02-0.61). The frequency of deaths due to anaphylaxis by drugs increased during the study period (IRR per year, 1.02, 95%CI 1.00-1.04). We detected considerable heterogeneity in almost all of the meta-analyses carried out. Conclusion: The incidence of fatal anaphylaxis is very low and differs according to the various subgroups analyzed. The studies were very heterogeneous. Fatal anaphylaxis due to food seems to be less common than fatal anaphylaxis due to drugs or Hymenoptera venom.