Background: Insect venom allergy is common and greatly impairs patients’ quality of life. Additionally, low compliance with carrying emergency medication is reported. The aim of our study was to analyze the disease burden, levels of anxiety and depression, and to evaluate attitudes towards the set of emergency medication in affected patients. Methods: Between April 2016 and January 2017, patients ≥18 years visiting our department because of an insect venom allergy were asked to complete a paper-based questionnaire. The questionnaire assessed willingness to pay (WTP), the Hospital Anxiety and Depression Scale (HADS), subjective anxiety levels, willingness to carry the set of emergency medication, self-assurance in using it, compliance with carrying it, and reasons for not always carrying it. Results: 55 patients (81.8% wasp allergy) were included. On average, WTP for a complete cure was EUR 1,727 (median: 500). Using the HADS, 14.5% showed definite anxiety disorders while 5.5% had significant depression disorders. Most patients stated to carry the emergency medication “always” (25.5%) or “almost always” (47.3%). “Forgetfulness” (36.4%) was reported as the main reason for not always carrying the medication, followed by “too big” (18.2%). Conclusions: In our patient cohort, insect venom allergy was associated with a moderate disease burden and a good compliance with carrying the emergency medication. However, several of our participants demonstrated borderline or significant anxiety and/or depression disorders. In this regard, this study highlights the necessity to regularly ask the patient about the psychological well-being to identify patients needing psychological support.

1.
Golden DB: Anaphylaxis to insect stings. Immunol Allergy Clin North Am 2015; 35: 287–302.
2.
Mueller HL: Diagnosis and treatment of insect sensitivity. J Asthma Res 1966; 3: 331–333.
3.
Dhami S, Zaman H, Varga EM, Sturm GJ, Muraro A, Akdis CA, Antolin-Amerigo D, Bilo MB, Bokanovic D, Calderon MA, Cichocka-Jarosz E, Oude Elberink JN, Gawlik R, Jakob T, Kosnik M, Lange J, Mingomataj E, Mitsias DI, Mosbech H, Ollert M, Pfaar O, Pitsios C, Pravettoni V, Roberts G, Rueff F, Sin BA, Asaria M, Netuveli G, Sheikh A: Allergen immunotherapy for insect venom allergy: a systematic review and meta-analysis. Allergy 2017; 72: 342–365.
4.
Oude Elberink JN: Significance and rationale of studies of health-related quality of life in anaphylactic disorders. Curr Opin Allergy Clin Immunol 2006; 6: 298–302.
5.
Confino-Cohen R, Melamed S, Goldberg A: Debilitating beliefs, emotional distress and quality of life in patients given immunotherapy for insect sting allergy. Clin Exp Allergy 1999; 29: 1626–1631.
6.
Oude Elberink JN, De Monchy JG, Van Der Heide S, Guyatt GH, Dubois AE: Venom immunotherapy improves health-related quality of life in patients allergic to yellow jacket venom. J Allergy Clin Immunol 2002; 110: 174–182.
7.
Goldberg A, Confino-Cohen R: Insect sting-inflicted systemic reactions: attitudes of patients with insect venom allergy regarding after-sting behavior and proper administration of epinephrine. J Allergy Clin Immunol 2000; 106: 1184–1189.
8.
Oude Elberink JN, de Monchy JG, Golden DB, Brouwer JL, Guyatt GH, Dubois AE: Development and validation of a health-related quality-of-life questionnaire in patients with yellow jacket allergy. J Allergy Clin Immunol 2002; 109: 162–170.
9.
Fischer J, Feidt A, Giel KE, Martens U, Zipfel S, Biedermann T, Teufel M: Quality-of-life in wasp venom allergy – validation of the German version of the “Vespid Allergy Quality of Life Questionnaire” (VQLQ-d). J Dtsch Dermatol Ges 2011; 9: 379–385.
10.
Armisen M, Guspi R, Alfaya T, Cruz S, Fernandez S, Dominguez-Noche C, Alonso A, Dalmau G, Marques L, Vega A: Cross-sectional validation of a quality of life questionnaire in Spanish for patients allergic to hymenoptera venom. J Investig Allergol Clin Immunol 2015; 25: 176–182.
11.
Silva D, Pereira AM, Santos N, Amaral L, Delgado L, Oude Elberink JN, Coimbra A: The Vespid Allergy Quality of Life Questionnaire – cultural adaptation and translation to Portuguese. Eur Ann Allergy Clin Immunol 2017; 49: 114–121.
12.
Lundberg L, Johannesson M, Silverdahl M, Hermansson C, Lindberg M: Quality of life, health-state utilities and willingness to pay in patients with psoriasis and atopic eczema. Br J Dermatol 1999; 141: 1067–1075.
13.
Schiffner R, Schiffner-Rohe J, Gerstenhauer M, Hofstadter F, Landthaler M, Stolz W: Willingness to pay and time trade-off: sensitive to changes of quality of life in psoriasis patients? Br J Dermatol 2003; 148: 1153–1160.
14.
Beikert FC, Langenbruch AK, Radtke MA, Kornek T, Purwins S, Augustin M: Willingness to pay and quality of life in patients with atopic dermatitis. Arch Dermatol Res 2014; 306: 279–286.
15.
Beikert FC, Langenbruch AK, Radtke MA, Augustin M: Willingness to pay and quality of life in patients with rosacea. J Eur Acad Dermatol Venereol 2013; 27: 734–738.
16.
Schiffner R, Brunnberg S, Hohenleutner U, Stolz W, Landthaler M: Willingness to pay and time trade-off: useful utility indicators for the assessment of quality of life and patient satisfaction in patients with port wine stains. Br J Dermatol 2002; 146: 440–447.
17.
Radtke MA, Schafer I, Gajur A, Langenbruch A, Augustin M: Willingness-to-pay and quality of life in patients with vitiligo. Br J Der-matol 2009; 161: 134–139.
18.
Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361–370.
19.
Bjelland I, Dahl AA, Haug TT, Neckelmann D: The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002; 52: 69–77.
20.
Hinz A, Brähler E: Normative values for the Hospital Anxiety and Depression Scale (HADS) in the general German population. J Psychosom Res 2011; 71: 74–78.
21.
Nowak N, Bazan-Socha S, Pulka G, Pelka K, Latra P: Evaluation of the quality of life in subjects with a history of severe anaphylactic reaction to the Hymenoptera venom. Pneumonol Alergol Pol 2015; 83: 352–358.
22.
Cichocka-Jarosz E, Brzyski P, Swiebocka E, Lange J, Tobiasz-Adamczyk B, Lis G, Jedynak-Wasowicz U, Kulus M, Kaczmarski M, Malaczynska T, Klajna-Kraluk B, Breboro-wicz A, Kycler Z, Pietrzyk JJ: Health-related quality of life in Polish adolescents with Hymenoptera venom allergy treated with venom immunotherapy. Arch Med Sci 2012; 8: 1076–1082.
23.
Oude Elberink JN, Dubois AE: Quality of life in insect venom allergic patients. Curr Opin Allergy Clin Immunol 2003; 3: 287–293.
24.
Alfaya T, Vega A, Dominguez-Noche C, Ruiz B, Marques L, Sanchez-Morillas L: Longitudinal validation of the Spanish version of the Health-Related Quality of Life Questionnaire for Hymenoptera Venom Allergy (HRQLHA). J Investig Allergol Clin Immunol 2015; 25: 426–430.
25.
Sanchez J: Anaphylaxis. How often patients carry epinephrine in real life? Rev Alerg Mex 2013; 60: 168–171.
26.
Oude Elberink JN, van der Heide S, Guyatt GH, Dubois AE: Analysis of the burden of treatment in patients receiving an EpiPen for yellow jacket anaphylaxis. J Allergy Clin Immunol 2006; 118: 699–704.
27.
Cohen MB, Saunders SS, Wise SK, Nassif S, Platt MP: Pitfalls in the use of epinephrine for anaphylaxis: patient and provider opportunities for improvement. Int Forum Allergy Rhinol 2017; 7: 276–286.
28.
Pumphrey RS: Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy 2000; 30: 1144–1150.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.