ArticleEmergency medicine journal : EMJ2004
Insect sting anaphylaxis; prospective evaluation of treatment with intravenous adrenaline and volume resuscitation.
Article in Emergency medicine journal : EMJ, 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 2 of them syntheses that pooled it.
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Who cites it
41 citing papers in PubMed, 2 syntheses or guidelines pooled it, 216 citations in OpenAlex.
- Systematic review of outcome measures in trials of pediatric anaphylaxis treatment.BMC pediatrics · 2014Pooled it
- Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock.The Cochrane database of systematic reviews · 2008Pooled it
- [How I treat anaphylaxis in children].Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics · 2026Article
- Mechanism of Cardiac Arrest in Fatal Anaphylaxis.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2026Article
- Ceftriaxone-induced Kounis syndrome presenting with arrhythmia: a case report and literature review from a resource-limited setting.Annals of medicine and surgery (2012) · 2026Article
- Adrenaline Auto-Injectors for Preventing Fatal Anaphylaxis.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2025Review
- Management of Refractory Anaphylaxis: An Overview of Current Guidelines.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2024Review
- Refractory Anaphylaxis: A New Entity for Severe Anaphylaxis.The journal of allergy and clinical immunology. In practice · 2023Review
- Who Needs Epinephrine? Anaphylaxis, Autoinjectors, and Parachutes.The journal of allergy and clinical immunology. In practice · 2023Review
- Investigation of the underuse of adrenaline (epinephrine) and prognosis among patients with anaphylaxis at emergency department admission.Frontiers in medicine · 2023Article
- Article
- Emergency treatment of anaphylaxis: concise clinical guidance.Clinical medicine (London, England) · 2022Article
- Comment on Fierro et al. Severe Hypotension, Bradycardia and Asystole after Sugammadex Administration in an Elderly Patient.Medicina (Kaunas, Lithuania) · 2022Article
- A Clinical Practice Guideline for the Emergency Management of Anaphylaxis (2020).Frontiers in pharmacology · 2022Article
- Evidence update for the treatment of anaphylaxis.Resuscitation · 2021Review
- Cardiovascular changes during peanut-induced allergic reactions in human subjects.The Journal of allergy and clinical immunology · 2021Observational
- Limited effect of intramuscular epinephrine on cardiovascular parameters during peanut-induced anaphylaxis: An observational cohort study.The journal of allergy and clinical immunology. In practice · 2021Observational
- World allergy organization anaphylaxis guidance 2020.The World Allergy Organization journal · 2020Article
- Kounis syndrome: A rare case.Journal of family medicine and primary care · 2020Article
- Acute myocardial injury after administration of intravenous epinephrine for allergic reaction.SAGE open medical case reports · 2020Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess a protocol for treatment of sting anaphylaxis.
designProspective assessment of treatment with oxygen, intravenous infusion of adrenaline (epinephrine), and volume resuscitation with normal saline.
settingSub-study of a venom immunotherapy trial.
participants21 otherwise healthy adults with systemic allergic reactions to diagnostic sting challenge.
main outcome measuresResponse to treatment, total adrenaline dose and infusion duration, recurrence of symptoms after stopping the infusion, and additional volume resuscitation.
results19 participants required intervention according to the protocol. All received adrenaline, and five received volume resuscitation. In nine cases, physical signs of anaphylaxis recurred after initial attempts at stopping adrenaline but resolved after recommencing the infusion. The median total dose and infusion duration were 590 micro g and 115 minutes respectively, but were significantly higher for eight patients who had hypotensive reactions (762 micro g and 169 minutes respectively). Hypotension was always accompanied by a relative bradycardia, which was severe and treated with atropine in two patients. Widespread T wave inversion occurred, before starting treatment with adrenaline, in one person with an otherwise mild reaction. All patients fully recovered and were fit for same day discharge, apart from the person with ECG changes who was observed overnight and discharged the following day.
conclusionsCarefully titrated intravenous adrenaline combined with volume resuscitation is an effective strategy for treating sting anaphylaxis, however severe bradycardia may benefit from additional treatment with atropine. Cardiac effects of anaphylaxis, perhaps including neurocardiogenic mechanisms, may be an important factor in some lethal reactions.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.