Insect venom allergy is the most frequent cause of anaphylaxis in Europe and possibly worldwide. The majority of systemic allergic reactions after insect stings are caused by Hymenoptera and among these, vespid genera induce most of the systemic sting reactions (SSR). Honey bees are the second leading cause of SSR. Depending on the global region, other Hymenoptera such as different ant genera are responsible for SSR. Widely distributed hornets and bumblebees or local vespid or bee genera rarely induce SSR. Hematophagous insects such as mosquitoes and horse flies usually cause (large) local reactions while SSR occasionally occur. This position paper aims to identify either rare or locally important insects causing SSR as well as rarely occurring SSR after stings or bites of widely distributed insects. We summarized relevant venom or saliva allergens and intended to identify possible cross-reactivities between the insect allergens. Moreover, we aimed to locate diagnostic tests for research and routine diagnosis, which are sometimes only regionally available. Finally, we gathered information on disposable immunotherapies. Major allergens of most insects were identified, and cross-reactivity between insects was frequently observed. While some diagnostics and immunotherapies are locally available, standardized skin tests and immunotherapies are generally lacking in rare insect allergy.

Introduction and objective Drugs are a frequent cause of severe anaphylactic reactions. Clinical epidemiology of drug-induced anaphylaxis (DIA) supports the identification of the most frequent eliciting drug groups, risk factors, symptoms and treatment procedures. Our aim was to analyze data to promote better recognition and long-term management of affected individuals. Methods Data from the European Anaphylaxis Registry (2007-2019) with 1,815 cases of drug-induced anaphylaxis were analyzed regarding demographics, elicitors, symptoms, comorbidities, and treatment. Results The most frequent eliciting groups of drugs were analgesics (41.27%) – with non-steroidal anti-inflammatory drugs (NSAIDs) being the most common subgroup (65.42%) – antibiotics (33.17%), local anesthetics (7.38%) and radiocontrast media (5.18%). Adrenaline was used more often in patients with DIA (23.20%) than in anaphylaxis due to other causes (17.82%). The majority of events occurred in female patients (65.34%), although they were admitted to hospital (29.01%) or an intensive care unit (ICU) (9.61%) less often. Skin symptoms were most common (84.02%), while gastrointestinal symptoms were reported less frequently (30.25%). Compared to other anaphylactic reactions in the registry (food/insects) severe reactions occurred significantly more often in DIA (5.62% vs. 1.67%). Hospitalization (31.63%) and ICU admission rates (11.85%) were significantly higher in DIA than anaphylactic reactions to other elicitors (27.58% and 5.45%). Conclusions DIA affects middle aged females more frequently and is more severe in elderly males in the sample observed. Analgesics and antibiotics are the leading causes of DIA. Adrenaline was rarely administered to patients, even though it is recommended by guidelines.

An increased basal cholinergic tone, induced by psychological health impairment, could be a likely link between psychological/psychiatric disorders and severe bronchial asthma in children, as well as in adolescents and adults. This link can explain the high rate of anxiety in asthmatics in comparison to non-asthmatics of all ages.

Background This systematic review used the GRADE approach to compile evidence to inform an anaphylaxis guideline from the European Academy of Allergy and Clinical Immunology (EAACI). Methods We searched five bibliographic databases from 1946 to 20 April 2020 for studies about the diagnosis, management and prevention of anaphylaxis. We included 50 studies with 18,449 participants: 29 randomised controlled trials, seven controlled clinical trials, seven consecutive case series and seven case-control studies. Findings were summarised narratively because studies were too heterogeneous to conduct meta-analysis. Results It is unclear whether the NIAID/FAAN criteria or Brighton case definition are valid for immediately diagnosing anaphylaxis due to the very low certainty of evidence. Adrenaline is the cornerstone of first-line emergency management of anaphylaxis but, due to ethical constraints, little robust research has assessed its effectiveness . Newer models of adrenaline autoinjectors may slightly increase the proportion of people correctly using the devices and reduce time to administration. Face-to-face training for laypeople may slightly improve anaphylaxis knowledge and competence in using autoinjectors. Adrenaline prophylaxis prior to snake bite anti-venom may reduce anaphylaxis but the impact of prophylactic corticosteroids and antihistamines is uncertain. There was insufficient evidence about the impact of other anaphylaxis management strategies. Conclusions Anaphylaxis is a potentially life-threatening condition but, due to practical and ethical challenges, there is a paucity of robust evidence about how to diagnose and manage it.