Venom

Question 1

Risk factors for severe reactions to stings

Answer 1

1. very severe previous reaction
2. insect species
3. age >45 years
4. male sex
5. multiple sequential stings
6. Meds (ACE)

Question 2

What is the risk of a systemic reaction in pts that had a large local to venom sting?

Answer 2

4-10%

Question 3

How many people die a year from stings?

Answer 3

40 estimated in US

0.4-0.8% risk of children and 3% of adults

Question 4

Mgmt for venom allergy

Answer 4

1. Be educated on avoidance of stings
2. Carry Epi and understand indications and administration
3. Undergo testing sIgE
4. Consider VIT
5. Carry medical ID for Venom allergy

Question 5

Reasons for a negative venom SPT

Answer 5

1. Refractory period - Testing too soon after rxn
2. alternative diagnosis: mastocytosis, or other MCAS

Question 6

Venom SPT doses

Answer 6

1. SPT with 100 mcg/ml
2. ID with 0.01 mcg/ml, 0.1 mcg/ml, then 1 mcg/ml
   some papers say skip SPT and do 1 mcg/ml ID testing

Question 7

VIT schedule

Answer 7

Vial 1 (1 mcg/ml)
- 0.10 ml
- 0.50 ml
- 1.0 ml
Vial 2 (10 mcg/ml)
- 0.1 ml
- 0.50 ml
- 1.0 ml
Vial 3 (100 mcg/ml)
- 0.15 ml
- 0.15 ml
- 0.30 ml
- 0.30 ml
- 0.50 ml
- 0.50 ml

Question 8

what is the dose of venom per sting

Answer 8

vespids (hornets/wasps/YJ) have 2-20ug of venom per sting

100 mcg dose of YJ is roughly 5-50 stings (2 stings for Honey bee)

Question 9

Risk factors for severe reactions to stings

Answer 9

1. very severe previous reaction
2. insect species
3. age > 45 years
4. medications like acei

Question 10

antigen used to standardize honey bee and yj

Answer 10

HB- phospholipase A2
YJ - hyaluronidase ves v2

Question 11

components in honey bee venom

Answer 11

api m1 - phospolipase a2
api m2- hyaluronidase
api m3 - melittin

Question 12

components in vespid

Answer 12

dol m1
dol m2 - hyaluronidase
dol m3
dol m5 - antigen 5

Question 13

components in fire ants

Answer 13

sol 1
sol 2
sol 3
sol 4

Question 14

which insects are part of vespidae class

Answer 14

• YJ
• WFH
• paper wasp

Question 15

which insects are part of the apidae class

Answer 15

• honey bee

Question 16

which insects are part of the formicidae class

Answer 16

• fire ant
• harvester ant

Question 17

what dose is used for VIT intradermal/ intracut. testing?

Answer 17

1.0 mcg/ml

Question 18

When to measure a basal serum tryptase?

Answer 18

1. severe reaction to a sting
2. hypotensive reaction
3. lack of urticaria in systemic reaction to s ting
4. systemic reaction to a stinng with a negative venom IgE results

consider
1. systemic reaction to VIT
2. before d/c’ing VIT
3. any candidate for VIT

Question 19

factors for elevated risk of relapse after discontinuing VIT

Answer 19

Proven
1. very severe reaction to previous stings
2. elevated basal serum tryptase level
3. systemic reactions during VIT
4. less than 5 years of maintenance VIT
5. Honey bee anaphylaxis
6. frequent exposure

Possible
1. no decrease in venom IgE or SPT
2. underlying CVS/resp disease
3. Use of ACEi or BB