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  Authority of Polish Society of Allergology

vol 15. no 2. June 2010  

 Original articles
Comparison of the practice in management with adults and children sensitized to hymenoptera venom in Poland
E. Cichocka-Jarosz, P. Brzyski, A. Bręborowicz, A. Bodzenta-Łukaszyk, M. Chełmińska, A. Dąbrowski, R. Gawlik, G. Gąszczyk, V. Grycmacher-Łatwo, K. Jahnz-Różyk, U. Jedynak-Wąsowicz, M. Jutel, B. Klajna-Kraluk, M. L. Kowalski, J. Kruszewski, P. Kuna, A. Kwaśniewski, Z. Kycler, J. Lange, G. Lis, T. Małaczyńska, M. Nittner-Marszalska, K. Pałgan, J. Pietraszek-Mamcarz, J. J. Pietrzyk, †A. Poszwiński, G. Pulka, M. Stobiecki, E. Świebocka, E. Trębas-Pietraś, M. Zakrzewska, J. Zaryczański

Introduction. Management with both adults and children sensitized to Hymenoptera venoms is highly specialist in-hospital procedure in Poland. Rules of management don’t differ between adults and children older than 5.
Aim. Comparison of diagnosis and treatment practice between adults and children with Hymenoptera venom allergy in Poland.
Material and methods. Questionnaire survey based on a original British survey was conducted in all internal medicine (18) and paediatric (8) allergy centres in Poland.
Results. The first line of investigation both in adults and children are simultaneously performed SPT and SSIgE. Aqueous venom extracts are the most common product in diagnosis (as recommended) and treatment (optional). In case of negative first line results almost all centres for adults, and majority centres for children perform IDT. Baseline serum tryptase levels are available in 40% internal and paediatric centres. Rush is predominating initial treatment in adults, while ex equo conventional and ultra-rush in children. A target maintenance dose equal to 100 mcg is a standard for majority of centres. Premedication with H1 receptor opposite agonists is almost a routine in adults and children management. Six-week interval between a booster doses is obeyed in half of internal medicine and paediatric centres. Five years is an optimal VIT duration in majority of centres. One half of centres consider stinging challenge before the VIT completion.
Conclusions. Both in internal medicine and paediatric allergy centres there is a high standard of procedures introduced into the practice in management with venom allergic patients. Improvement should concern: a) better availability of baseline serum tryptase evaluation in patients with the history of severe sting reaction, b) routine taking blood sample within 1-2 hours from the beginning of severe anaphylactic symptoms in patients after being stung, c) after considering risk/benefit ratio in patients with risk of severe anaphylactic reaction, better protection with intervention drugs including adrenaline syringe.

keywords: swoiste IgE, testy skórne, immunoterapiaswoista na jad owadów błonkoskrzydłych, dorośli, dzieci, serum venom-specific IgE, skin tests, diagnosis, specific venom immunotherapy, Hymenoptera venom allergy, adults, children

pages: from 86 to 91

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