Venom Anaphylaxis — SCE Dermatology MCQ

Correct answer: B — Prescribe an Adrenaline auto-injector and refer for venom immunotherapy assessment

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · A = shown as D · C = shown as E

D is correct (Prescribe an Adrenaline auto-injector and refer for venom immunotherapy assessment). This woman has had a systemic allergic reaction (widespread urticaria and angioedema requiring IM adrenaline) to a wasp sting, which places her at significant risk of a further, potentially more severe, anaphylactic reaction on re-sting. BSACI guidance states that patients with a systemic reaction should be immediately provided with a written emergency plan and an adrenaline auto-injector with training, and should be referred for specialist allergy assessment for venom immunotherapy (VIT). VIT is the only disease-modifying treatment and is highly effective, protecting the great majority of wasp-venom-allergic patients from further systemic reactions on re-sting. Confirmation of venom-specific IgE and specialist assessment determine suitability before VIT is started. Why the other options are wrong: A. Avoidance of all outdoor activities: unrealistic, disproportionate, and does not address the underlying IgE-mediated allergy; sting avoidance advice is given but total lifestyle restriction is not evidence-based management. B. Prophylactic oral corticosteroids: steroids have no proven role in preventing future venom-induced anaphylaxis and are not part of standard prophylaxis; they only feature in acute reaction management, not long-term prevention. C. Oral antihistamines for life: antihistamines treat cutaneous symptoms only and do not prevent or attenuate life-threatening anaphylaxis, so they are inadequate as sole long-term management after a systemic reaction. E. No further action required: incorrect and dangerous, since a systemic reaction to venom carries a high risk of recurrence and mandates both rescue medication provision and specialist referral. Key point: a systemic (anaphylactic) reaction to a wasp or bee sting mandates an adrenaline auto-injector plus specialist referral for venom immunotherapy, the only treatment that alters long-term sting-reaction risk.

Reference: BSACI Guideline: Diagnosis and management of Hymenoptera venom allergy (Krishna et al., Clin Exp Allergy 2011, updated BSACI Venom Allergy guidance) - https://www.bsaci.org/guidelines-and-standards/bsaci-guidelines/venom-allergy/