Insect sting-inflicted systemic reactions: Attitudes of patients with insect venom allergy regarding after-sting behavior and proper administration of epinephrine

Background: Patients with insect venom allergy are at higher risk for devel opment of a recurrent systemic reaction after resting This risk significant ly decreases with venom immunotherapy, Patients with insect venom allergy s hould be able to distinguish a life-threatening systemic reaction from all other various reactions after an insect sting. Accidental epinephrine injec tion by EpiPen has been reported in the past. Therefore patients with venom allergy should also be web trained in self-administration of their epineph rine when needed Objective: Our objective was to assess patients' attitudes regarding after-sting behavior and their capability to correctly self-admi nister the epinephrine autoinjector, Methods: All patients with venom allergy attending our allergy unit either before commencement of or during venom immunotherapy answered a questionnai re addressing various aspects of their intended after-sting behavior. Using an EpiPen trainer device, patients' performance of EpiPen self-administrat ion was evaluated. Results: Ninety-six patients participated in the study, Seventy-six of them were equipped with an EpiPen device. Less than 30% of these patients carri ed it at all times. After re-sting 50 (54%) patients planned to wait for th e development of other symptoms before taking any further action. Twenty-tw o percent of the patients said that after re-sting they mould immediately a dminister their EpiPen. Proper EpiPen administration technique was demonstr ated by 44% of the patients. Having not reached the maintenance dose correl ated with a better compliance with carrying of the EpiPen, EpiPen instructi on provided by an allergist correlated with a better EpiPen administration technique by the patients. Conclusion: Many patients with venom allergy hold wrong ideas about after-s ting behavior. Compliance with carrying EpiPen at all times and the ability to correctly administer it are both poor in most patients. Thorough and pr obably repeated instruction, both written and oral provided by knowledgeabl e physicians is mandatory.