Climate data, localisation of the sting, grade of anaphylaxis and therapy of hymenoptera stings

• Published in: Swiss medical weekly Vol. 146; no. 506; p. w14272
• Main Authors: Braun, Christian Tasso, Mikula, Mirko, Ricklin, Meret Elisabeth, Exadaktylos, Aristomenis K, Helbling, Arthur
• Format: Journal Article
• Language: English
• Published: Switzerland SMW supporting association (Trägerverein Swiss Medical Weekly SMW) 2016
• Subjects: Administration, Intravenous; adrenaline; Adult; Aged; Aged, 80 and over; Air Pressure; Anaphylaxis - drug therapy; Anaphylaxis - epidemiology; Animals; Arm; Cohort Studies; Emergency Service, Hospital; Epinephrine - therapeutic use; Female; Glucocorticoids - therapeutic use; Head; Histamine Antagonists - therapeutic use; Hospitals, University; Humans; Humidity; Hymenoptera; Insect Bites and Stings - drug therapy; Insect Bites and Stings - epidemiology; Leg; Male; Middle Aged; Rain; Retrospective Studies; Severity of Illness Index; Sunlight; Switzerland - epidemiology; Sympathomimetics - therapeutic use; Weather; Young Adult
• DOI: 10.4414/smw.2016.14272
• ISSN: 1424-7860

International epidemiological studies indicate that around 1-7% of the population respond with an allergic reaction to a hymenoptera sting, which is frequently associated with admission to an emergency department. This retrospective study included patients admitted between 2009 and 2013 to an emergency department after a hymenoptera sting. In all, 86 (60.1%) men and 57 (39.9%) women were included in the study. The mean age was 43 years, with a range from 19 to 84 years. The most common localisations of a sting were the head (n = 33; 22.5%), the hands (n = 32; 21.9%) and the arms (n = 26; 17.8%). In women, we recorded significantly more stings in distal extremities (p = 0.033) and in men stings in the rump and head were most frequent. Local swellings were observed in 67.1% (n = 96) of patients and 34.3% (n = 49) patients exhibited an anaphylactic reaction. Of these, 21.7% (n = 31) suffered from a grade I, 6.3% (n = 9) grade II, 4.2% (n = 6) grade III and 2.1% (n = 3) grade IV anaphylactic reactions. 46% (66) of the patients were given antihistamines, 45% (64) intravenous glucocorticoids and only 12.5% (16) epinephrine. Most stings were recorded on days without rainfall (p = 0.013), with more hours of sunshine (p = 0.001), low relative humidity (p = 0.006), with mean air pressure above 954.3 hPa and on days with mean temperature above 24.2 °C (p = 0.001). In conclusion, the most hymenoptera stings induced local swelling only; severe reactions were rare. The most dangerous stings are enoral and result from inattentive drinking. Epinephrine was rarely used in anaphylactic reactions.