Bee and wasp induced anaphylaxis in Southern Denmark in the period 2008-2011

Background: Bee and wasp stings are described as one of the three most common cause of anaphylaxis in children and adults. Primary treatment is usually performed at pre-hospital level. This study aims to estimate the severity of anaphylaxis to bee and wasp stings and the correlation to the treatment administrated at pre-hospital level. Method: A retrospective study based on diagnosis (ICD-10) from The Mobile Emergency Care Unit (MECU) in the Region of Southern Denmark (2008-2011). Discharge summaries from the MECU and acute ward on the Hospitals were reviewed in order to assess the severity of the anaphylactic reaction according to Sampson 2003 and Mueller 1966. Treatment was evaluated in relation to administration of adrenaline and other drugs. Results: Ninety three patients (26 women, 67 men; mean age 49 years) were evaluated during the study period. Moderate to severe anaphylaxis was found in 63% according to Sampson (47% according to Mueller). One death was registered. Intramuscular (IM) adrenaline was given to the patients with moderate to severe anaphylaxis in 56% of the relevant cases. In the same group, 86% received intravenous (IV) glucocorticoids and 85% IV antihistamine. Conclusion: More than 50% of the cases were graduated as moderate to severe anaphylaxis (Sampson 3-5 and Mueller 2-4). In discordance with current guidelines, only 56-57% with moderate to severe anaphylaxis received treatment with IM adrenaline, while most of the patients were treated with IV antihistamine and glucocorticoids.