Epinephrine
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Myocardial infarction following wasp stings: case report A 41-year-old man developed acute inferior-wall myocardial infarction after receiving SC epinephrine [adrenaline] for anaphylaxis due to wasp stings. The man, who had a history of hypercholesterolaemia, smoking and angina pectoris, was stung by three wasps and, 5 minutes later, developed anaphylaxis, for which he received sequentially IM corticosteroids and antihistamines, followed by SC epinephrine 0.5mg. Soon after, he developed crushing chest pain with ST-segment elevations in the inferior leads [time to reaction onset not stated]. In a Coronary Unit, he was diagnosed with an acute inferior-wall myocardial infarction; he had an elevated troponin T level. The man’s symptoms resolved after sublingual nitroglycerin [glyceryl trinitrate] treatment. He had a positive intradermal skin test reaction to wasp and an increased vespula venomspecific serum IgE level (2.47 kU/mL). He subsequently underwent a successful immunotherapy with vespula venom, administered by a rapid cluster schedule in an ICU. Author comment: "In this case, probable pathogenic mechanisms of acute myocardial damage, include the anaphylactic reaction itself, the action of wasp venom constituents and therapeutic intervention with [epinephrine]." Iglesias Souto J, et al. Anaphylaxis and acute myocardial infarction after wasp stings. Is always adrenaline a safe treatment? Allergy 62 (Suppl. 83): 113 abstr. 801104913 295, 2007 - Spain
0114-9954/10/1194-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 22 Mar 2008 No. 1194
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