macro

what bug circumstances? location of string local, large local, or systemic timing and duration post sting rash, pustules, resp, gi, cardio anaphylaxis? consistent hx exposure risk treatment

AP:

• Skin testing prior to intradermal may be considered if hx of anaphylaxis
• Otherwise, intradermal testing doses are titrated up until positive result (gives baseline for venom therapy) *** A skin test may be negative in the days or weeks after a sting reaction, which may be attributed to a refractory period of anergy; for these patients, the skin test should be repeated after 4–6 weeks

***non systemic reactions .The symptoms often last a few days to a week. The risk of a systemic reaction with a subsequent sting is about 5-10% which is only slightly higher than the general population (2-5%). Because of the low risk immunotherapy is not necessary but may be offered if the patient gets stung often and has frequent reactions as it will decrease the severity of the large local reactions.

***confirmed venom allergy Systemic reactions to stinging insects have a 30-60% risk of a subsequent potentially life threatening reaction with another sting. -The allergen of concern was identified today as

• Workup: baseline serum tryptase if history of anaphylaxis or atypical reaction

We counseled on sting avoidance techniques such as not eating/drinking outside, wearing shoes when walking in the grass and having nests professionally removed from the property We have prescribed an epinephrine autoinjector and discussed its use Venom immunotherapy (VIT) is indicated in the setting of anaphylaxis and skin or sIgE evidence of sensitization, and can reduce the risk of a systemic reaction to around 5% once maintenance dosing is achieved