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Golden DBK, Tracy JM. Venom immunotherapy: What is the rush? Ann Allergy Asthma Immunol 2024; 133:360-361. [PMID: 39293900 DOI: 10.1016/j.anai.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 07/18/2024] [Indexed: 09/20/2024]
Affiliation(s)
- David B K Golden
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - James M Tracy
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska.
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McMurray JC, Adams KE, Wanandy T, Le A, Heddle RJ. Stinging Ant Anaphylaxis: Advances in Diagnosis and Treatment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00745-1. [PMID: 39038538 DOI: 10.1016/j.jaip.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 06/27/2024] [Accepted: 07/07/2024] [Indexed: 07/24/2024]
Abstract
Stinging ants represent a wide range of over 200 different species across the world, of which Solenopsis, Myrmecia, Pogonomyrmex, and Brachyponera genera account for a substantial economic and healthcare burden. S. invicta (red imported fire ant [IFA]) and M. pilosula (jack jumper ant [JJA]) are 2 species of high clinical importance, known to cause anaphylaxis in humans, with numerous reported fatalities. Diagnostic testing should be performed in patients with a history of a systemic reaction with skin testing and/or in vitro specific immunoglobulin E (IgE) testing. In vitro testing is commercially available for IFA through whole-body extract specific IgE and JJA venom-specific IgE, but not widely available for other stinging ant species. Commercial venom component testing for IFA and JJA is currently not available. Patients with a clinical history and positive specific IgE testing should undergo treatment with specific immunotherapy, which is currently available for IFA and JJA. Buildup may be performed using conventional, semi-rush, rush, or ultra-rush schedules with similar risk profiles for IFA. Optimal duration for whole=body extract immunotherapy for IFA and specific JJA venom immunotherapy is not well studied, but generally recommended for at least 3 to 5 years. Sting challenges are used in research settings, primarily to assess treatment efficacy of immunotherapy.
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Affiliation(s)
- Jeremy C McMurray
- Allergy & Immunology Service, Walter Reed National Military Medical Center, Bethesda, Md.
| | - Karla E Adams
- Allergy & Immunology Service, Wilford Hall Ambulatory Surgical Center, San Antonio, Texas
| | - Troy Wanandy
- Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program, Royal Hobart Hospital, Hobart, Tasmania, Australia; College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia; National Allergy Centre of Excellence (NACE), Parkville, Victoria, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Adriana Le
- Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program, Royal Hobart Hospital, Hobart, Tasmania, Australia; College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia; National Allergy Centre of Excellence (NACE), Parkville, Victoria, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Robert J Heddle
- Department of Allergy and Immunology, University of Adelaide, Adelaide, South Australia, Australia
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Neaves BI, Coop CA. Imported fire ant immunotherapy. Ann Allergy Asthma Immunol 2024; 133:28-32. [PMID: 38281676 DOI: 10.1016/j.anai.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/30/2024]
Abstract
Imported fire ants (IFAs) permeate many areas of the United States. The IFA allergy is a significant health problem for children and adults. Stings from IFAs cause pustules, localized reactions, and anaphylaxis. There have been at least 32 deaths attributed to IFA stings. Because of the difficulty with the extraction of venom from the fire ants, whole body extracts are the only commercially available serum for immunotherapy. Fortunately, whole body extract immunotherapy given conventionally or through the rush method has proven to be efficacious and safe. It is recommended for the treatment of IFA hypersensitivity. Maintenance immunotherapy is typically given at 4-week intervals. However, more recent research has revealed that these intervals can gradually be extended up to 12 weeks similar to flying Hymenoptera venom immunotherapy. Long-term adherence to IFA immunotherapy remains an obstacle for many patients despite its potential as a life-saving treatment.
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Floyd ML, Adams KE, Golden DBK. Updates and Recent Advances on Venom Immunotherapy. CURRENT TREATMENT OPTIONS IN ALLERGY 2023; 10:1-19. [PMID: 37361640 PMCID: PMC10148014 DOI: 10.1007/s40521-023-00336-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review Venom immunotherapy has been utilized to treat Hymenoptera venom allergy since the 1920s. Over the last century, significant advances in the fields of immunology and genetics have led to improvements in the practice of venom immunotherapy. This review encompasses recent advances in the use of venom immunotherapy to provide precise, patient-centered care. Recent Findings Research about the mechanism of action of venom immunotherapy continues to highlight the modification of both the innate and adaptive immune systems. Molecular techniques have allowed for the identification of specific venom allergens to improve the diagnostic accuracy and safety of venom immunotherapy. Research continues to support the safety of accelerated schedules which can impact the cost, adherence, and quality of life for patients receiving this treatment modality. Finally, significant advances have led to the elucidation of risk factors that place patients at risk for reactions during and after venom immunotherapy. Creation of risk profiles for venom-allergic patients can thus inform the process of immunotherapy in order to provide personalized and precise care. Summary Significant progress in the use of venom immunotherapy makes the practice a dynamic and active field for continued research. Future research needs to build on these recent advances to continue to optimize and enhance this life-saving treatment.
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Affiliation(s)
- Michelle L. Floyd
- 42d Medical Group, Maxwell AFB, 300 South Twining Street, Building 760, Montgomery, AL 36112 USA
| | - Karla E. Adams
- Department of Medicine, Allergy and Immunology Division, Wilford Hall Ambulatory Surgical Center, Lackland AFB, 1100 Wilford Hall Loop, Bldg 4554, San Antonio, TX 78236 USA
| | - David B. K. Golden
- Johns Hopkins University, 25 Crossroads Drive #410, Owings Mills, MD 21117 USA
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Carlson JC, Hajirawala M, Hein N. Diagnosis and Management of Insect Allergy: Barriers and Facilitators in the United States. J Asthma Allergy 2022; 15:1773-1781. [PMID: 36544562 PMCID: PMC9762263 DOI: 10.2147/jaa.s364867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
While guidelines recommend testing and treatment for patients with venom-induced anaphylaxis to prevent morbidity and mortality, significant barriers prevent most patients from receiving the evaluation and treatments that they need. This review examines these barriers in the United States along with the facilitators that can be used to overcome them.
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Affiliation(s)
- John C Carlson
- Department of Pediatrics, Ochsner Health System, New Orleans, LA, USA,Correspondence: John C Carlson, Department of Pediatrics, Ochsner Health System, 1315 Jefferson Hwy, New Orleans, LA, 20121, USA, Tel +1-504-842-3900, Fax +1-504-842-5848, Email
| | - Monica Hajirawala
- Department of Pediatric Allergy and Immunology, University of South Florida, St. Petersburg, FL, USA
| | - Nina Hein
- Department of Allergy and Clinical Immunology, Tulane University, New Orleans, LA, USA
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Abstract
Accelerated allergy shot schedules for inhalant and venom allergens provide individuals with allergy symptom relief but in a shorter time frame than conventional therapy. Accelerated immunotherapy (IT) protocols allow patients to reach therapeutic doses in a shorter time frame while improving adherence and reducing direct costs (e.g., fewer office visits and medications) and indirect costs (e.g., less travel time, missed work or school). Rush IT and cluster IT are believed to work through mechanisms similar to conventional subcutaneous IT (SCIT). The risk for severe systemic reactions during accelerated IT is low when appropriately administered; however, life-threatening and fatal reactions do occur. To reduce the incidence of systemic allergic reactions during cluster and rush IT protocols, premedication is recommended. It is important to exclude individuals at high risk such as those with poorly controlled asthma or those who are on β-blockers to mitigate the risk for developing systemic allergic reactions. However, accelerated SCIT regimens offer increased convenience, faster improvement in allergy symptoms, and the potential to reduce health-care costs while providing equivalent safety outcomes compared with conventional IT protocols.
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Affiliation(s)
- Justin Greiwe
- From the Bernstein Allergy Group Inc, Cincinnati, Ohio; and
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Wang L, Wang C, Lou H, Zhang L. Antihistamine premedication improves safety and efficacy of allergen immunotherapy. Ann Allergy Asthma Immunol 2021; 127:363-371.e1. [PMID: 34052425 DOI: 10.1016/j.anai.2021.05.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Allergen immunotherapy (AIT)-associated adverse events are a major concern for safety and efficacy of AIT. Presently, there is no consensus to whether antihistamine premedication could improve such conditions. OBJECTIVE To identify the superiority of antihistamine pretreatment in AIT. METHODS A comprehensive literature search for randomized controlled trials reporting the effects of antihistamine premedication on safety and efficacy of AIT was performed in MEDLINE, Embase, and Cochrane Library databases. Safety was evaluated according to the number of patients reporting systemic adverse reactions (SARs, the primary outcome) and efficacy according to the number of patients achieving target maintenance dose (TMD) and sustained unresponsiveness to allergen. RESULTS A total of 11 randomized controlled trials (including 609 patients) satisfied the inclusion criteria for the meta-analysis. All premedication protocols were temporary. Pooled analysis revealed that compared with control patients, significantly fewer antihistamine-pretreated patients reported total and moderate-to-severe SARs (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.23-0.56; P < .05 and OR, 0.20; 95% CI, 0.06-0.74; P < .05, respectively) and total and moderate-to-severe SAR episodes (OR, 0.42; 95% CI, 0.34-0.53; P < .05 and OR, 0.09; 95% CI, 0.01-0.50; P < .05, respectively). Similarly, antihistamine pretreatment significantly increased the number of patients achieving TMD (OR, 2.94; 95% CI, 1.72-5.03; P < .05), but not sustained unresponsiveness (OR, 1.65; 95% CI, 0.77-3.54; P = 0.2), compared with the control group. Subgroup analysis according to different allergens and dose-escalating approaches also displayed superiority of antihistamine pretreatment than control. CONCLUSION Antihistamine premedication can markedly improve safety and efficacy of AIT by reducing frequency and severity of SAR and increasing TMD.
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Affiliation(s)
- Li Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, People's Republic of China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, People's Republic of China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China
| | - Hongfei Lou
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, People's Republic of China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China.
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, People's Republic of China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China; Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, People's Republic of China.
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Antolín-Amérigo D, Ruiz-León B, Vega-Castro A, de la Hoz Caballer B. Natural history of systemic reactions and risk factors in children and adults with Hymenoptera venom allergy. ALLERGO JOURNAL 2020. [DOI: 10.1007/s15007-020-0745-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Stinging insect allergy is uncommon but can be life threatening. Diagnosis requires clinical history and confirmative skin or blood testing by an allergist. Baseline serum tryptase level can be used to stratify risk. Treatment is supportive for all reactions except for anaphylaxis, which is treated with intramuscular epinephrine, recumbent posture, and adjunct measures such as IV fluids, and oxygen. Venom immunotherapy is most effective for long-term management in patients with a history of anaphylaxis. Venom immunotherapy rapidly reduces the risk of sting anaphylaxis by up to 98% and maintenance treatment can be stopped after 5 years in most cases.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, Manitoba R2A 5L9, Canada
| | - David B K Golden
- Department of Medicine, Johns Hopkins University School of Medicine, 20 Crossroads Drive Suite 16, Owings Mills, MD 21117, USA.
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Korošec P, Jakob T, Harb H, Heddle R, Karabus S, de Lima Zollner R, Selb J, Thong BYH, Zaitoun F, Golden DB, Levin M. Worldwide perspectives on venom allergy. World Allergy Organ J 2019; 12:100067. [PMID: 31700565 PMCID: PMC6829763 DOI: 10.1016/j.waojou.2019.100067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/14/2019] [Accepted: 09/06/2019] [Indexed: 01/15/2023] Open
Abstract
Venom immunotherapy is the standard of care for people with severe reactions and has been proven to reduce risk of future anaphylactic events. There is a moral imperative to ensure production, supply and worldwide availability of locally relevant, registered, standardized commercial venom extracts for diagnosis and treatment. Insects causing severe immediate allergic reactions vary by region worldwide. The most common culprits include honeybees (Apis mellifera), social wasps including yellow jackets (Vespula and Dolichovespula), paper wasps (Polistes) and hornets (Vespa), stinging ants (Solenopsis, Myrmecia, Pachycondyla, and Pogonomyrmex), and bumblebees (Bombus). Insects with importance in specific areas of the world include the Australian tick (Ixodes holocyclus), the kissing bug (Triatoma spp), horseflies (Tabanus spp), and mosquitoes (Aedes, Culex, Anopheles). Reliable access to high quality venom immunotherapy to locally relevant allergens is not available throughout the world. Many current commercially available therapeutic vaccines have deficiencies, are not suitable for, or are unavailable in vast areas of the globe. New products are required to replace products that are unstandardized or inadequate, particularly whole-body extract products. New products are required for insects in which no current treatment options exist. Venom immunotherapy should be promoted throughout the world and the provision thereof be supported by health authorities, regulatory authorities and all sectors of the health care service.
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Affiliation(s)
- Peter Korošec
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Thilo Jakob
- Department of Dermatoloy and Allergy, University Medical Center Giessen UKGM, Justus-Liebig-University, Giessen, Germany
| | - Harfi Harb
- National Center of Allergy, Asthma and Immunology, Riyadh, Saudi Arabia
| | | | - Sarah Karabus
- Division of Paediatric Allergy, University of Cape Town, South Africa
| | - Ricardo de Lima Zollner
- Laboratory of Translational Immunology, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Brazil
| | - Julij Selb
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | | | - David B.K. Golden
- Division of Allergy and Clinical Immunology, Johns Hopkins School of Medicine, Maryland, USA
| | - Michael Levin
- Division of Paediatric Allergy, University of Cape Town, South Africa
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Szari SM, Adams KE, Quinn JM, Stokes SC, Sacha JJ, White KM. Characteristics of venom allergy at initial evaluation: Is fire ant hypersensitivity similar to flying Hymenoptera? Ann Allergy Asthma Immunol 2019; 123:590-594. [PMID: 31491539 DOI: 10.1016/j.anai.2019.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/09/2019] [Accepted: 08/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hymenoptera venom allergy (HVA) is a well-established cause of anaphylaxis; however, studies comparing patients with imported fire ant (IFA) to flying hymenoptera (FH) allergies are lacking. OBJECTIVE This study sought to characterize the initial presentation and examine differences between patients with IFA and FH reactions. METHODS A multiyear (2007-2014), observational, single-institution analysis of patients referred for evaluation of HVA was performed. Data was obtained via physician interview, chart review and specific IgE results. RESULTS 175 patients were enrolled with no difference between FH and IFA patients when analyzing mean age, sex or likelihood to seek emergency department (ED) care. Asthma was similar in all groups at 21%. ED treatments were also similar (epinephrine: 32/150, 21%; antihistamines: 141/155, 91%; corticosteroids: 67/148, 45%). Reaction severity correlated with likelihood of ED visit (P <.001), use of epinephrine (P <.001) and corticosteroid use (P <.05). Patients presenting to the ED with anaphylaxis received epinephrine in 27/73 (37%) of cases. Overall, 149/175 (85%) patients in our cohort were confirmed to be sensitized to hymenoptera. Of those with positive testing 127/149 (85%) chose to pursue VIT. CONCLUSION IFA and FH patients have many similarities at presentation. Asthma occurred 2.5 times more frequently our cohort compared to the general US population. Epinephrine administration in our cohort was suboptimal. Children have initial reactions and are treated in the ED similarly to adults, with a notable (although not statistically significant) reduced use of epinephrine. The majority of patients seen in the ED and subsequently followed up in an allergy clinic had their venom allergy confirmed and initiated life-saving immunotherapy.
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Affiliation(s)
- Sofia M Szari
- Department of Allergy-Immunology, Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, Texas.
| | - Karla E Adams
- Department of Allergy-Immunology, Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, Texas
| | - James M Quinn
- Department of Allergy-Immunology, Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, Texas
| | - Shayne C Stokes
- Department of Allergy-Immunology, Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, Texas
| | - Joshua J Sacha
- Department of Allergy-Immunology, Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, Texas
| | - Kevin M White
- Department of Allergy-Immunology, Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, Texas
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Nath P, Adams K, Schapira R, Edwards K. Imported fire ant hypersensitivity and mastocytosis: A case series of successful venom immunotherapy. Ann Allergy Asthma Immunol 2019; 122:541-542. [PMID: 30831255 DOI: 10.1016/j.anai.2019.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/15/2019] [Accepted: 02/24/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Priya Nath
- Wilford Hall Ambulatory Surgical Center, Allergy/Immunology Clinic, Lackland Air Force Base, Texas.
| | - Karla Adams
- Wilford Hall Ambulatory Surgical Center, Allergy/Immunology Clinic, Lackland Air Force Base, Texas
| | | | - Kathryn Edwards
- Allergy/Immunology, Becker Ear, Nose, and Throat Center, Robbinsville, New Jersey
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Adams KE, Johnson KS. Safety of Repeated Imported Fire Ant Ultra-Rush Protocols. Mil Med 2018; 184:e483-e485. [DOI: 10.1093/milmed/usy275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/24/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Karla E Adams
- Department of Medicine, Allergy/Immunology Division, Wilford Hall Ambulatory Surgical Center, 1100 Wilford Hall Loop, Bldg 4554 San Antonio, TX
| | - Kimberly S Johnson
- Department of Medicine, Allergy/Immunology Division, Wilford Hall Ambulatory Surgical Center, 1100 Wilford Hall Loop, Bldg 4554 San Antonio, TX
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Golden DBK, Demain J, Freeman T, Graft D, Tankersley M, Tracy J, Blessing-Moore J, Bernstein D, Dinakar C, Greenhawt M, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Wallace D. Stinging insect hypersensitivity: A practice parameter update 2016. Ann Allergy Asthma Immunol 2017; 118:28-54. [PMID: 28007086 DOI: 10.1016/j.anai.2016.10.031] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
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Tankersley MS, Ledford DK. Stinging Insect Allergy: State of the Art 2015. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:315-22; quiz 323. [DOI: 10.1016/j.jaip.2015.03.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 02/07/2023]
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Ketotifen use in a patient with fire ant hypersensitivity and mast cell activation syndrome. Ann Allergy Asthma Immunol 2015; 114:443-6. [PMID: 25868710 DOI: 10.1016/j.anai.2015.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 03/10/2015] [Accepted: 03/15/2015] [Indexed: 11/21/2022]
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