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Additional info for Current Clinical Medicine, Second Edition
Negative skin tests can also occur in patients with a positive history who had remote sting reactions and have lost their sensitivity and in persons who had systemic non–IgE-mediated reactions as a result of toxic effects of the venom or underlying mastocytosis. Some patients with a positive history and a negative skin test do have venom-specific IgE antibodies in the serum that can be detected by serologic testing using a radioallergosorbent test (RAST). Venom skin tests do not correlate perfectly with serologic venom-specific IgE assays, which are negative in approximately 20% of patients with positive skin tests.
Clin Rev Allergy Immunol 1999;17:413-424. Hare ND, Ballas ZK: Effectiveness of delayed epinephrine in anaphylaxis. J Allergy Clin Immunol 2007;120:716-717. Lieberman P, Kemp SF, Oppenheimer J, et al: The diagnosis and management of anaphylaxis: An updated practice parameter. J Allergy Clin Immunol 2005;115:S483S523. Limb SL, Starke PR, Lee CE, Chowdhury BA: Delayed onset and protracted progression of anaphylaxis after omalizumab administration in patients with asthma. J Allergy Clin Immunol 2007;120:1378-1381.
TREATMENT Rapid recognition of an acute anaphylactic event is essential to prevent an adverse outcome. Initial steps to stabilize the patient should begin with an assessment of the patient’s airway and cardiopulmonary status (Box 4). The airway may be secured by intubation or emergent cricothyroidotomy if angioedema from anaphylaxis leads to airway compromise. Intravenous access should be obtained, and any obvious triggering antigen (for example, an insect stinger or an IV medication) should be removed if identified.