BACKGROUND: Chronic inducible urticaria (CIndU) management often follows chronic spontaneous urticaria (CSU) guidelines, but a step-by-step evaluation of their effectiveness in CIndU is lacking.
OBJECTIVE: To assess the clinical impact of adapting CSU international guidelines for CIndU management.
METHODS: We conducted a prospective cohort study involving patients diagnosed with CIndU based on challenge tests and a Urticaria Control Test (UCT) score of ≤11 points. Following the guidelines, a stepwise approach was used: avoidance measures, antihistamines, omalizumab, and cyclosporine. Treatment steps were added based on individual response, with control defined as UCT ≥12 points. Pharmacological steps were evaluated for at least 1 month, with the next step initiated in case of a UCT score ≤11 points.
RESULTS: We enrolled 194 patients with CIndU. Of them, 134 patients had CIndU with concomitant CSU and 60 had CIndU only. Following the step-by-step approach outlined in the guidelines, a total of 159 (81.9%) patients reach a UCT ≥12 points, with avoidance measures 23 (11.8%) patients, antihistamines 84 (43.2%), omalizumab 35 (18%), and cyclosporine 17 (8.7%).
CONCLUSIONS: This study supports the use of a stepwise approach based on CSU guidelines for CIndU management. However, a significant proportion of patients, particularly those with CIndU only, did not achieve adequate control. This highlights the heterogeneity within CIndU and the need for further research to develop new therapies for patients with CIndU who remain uncontrolled.

暂无摘要。

Management of urticaria can be optimized with clinical practice guidelines (CPGs). However, the quality of recent urticaria CPGs remains unclear.
To identify and appraise urticaria CPGs worldwide published in the last 5 years.
A search for relevant urticaria CPGs was conducted between January 1, 2017, and May 31, 2022, using the following databases: MEDLINE, Embase, National Institute for Health and Care Excellence (NICE) Evidence Search, Guidelines International Network, ECRI Guidelines Trust, Australian Clinical Practice Guidelines, Trip Medical Database, and DynaMed. The included CPGs were critically appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, Lenzer et al\'s red flags, and the Institute of Medicine (IOM) criteria of trustworthiness.
We included 21 urticaria CPGs. Most guidelines reviewed treatment recommendations of chronic spontaneous urticaria. The majority of guidelines were from European and Asian countries with high and high-middle sociodemographic index, written in English, and openly accessible. Seventeen guidelines (81%) had at least 1 AGREE II domain rated poor quality. Applicability, rigor of development, and stakeholder involvement were the 3 AGREE II domains that scored the lowest across guidelines. Appraisal with Lenzer et al\'s red flags showed that 18 guidelines (86%) raised at least 1 red flag indicating potential bias. The top 3 domains raising red flags were: no inclusion of nonphysician experts/patient representative/community stakeholders, no or limited involvement of a methodologist in the evaluation of evidence, and lack of external review. Based on IOM\'s criteria of trustworthiness, 20 guidelines (95%) had 1 or more criteria that did not meet best practice standards. The 3 domains with the highest number of best practice standards not met were updating procedures, rating strength of recommendations, and external review. Guidelines scored highest for the AGREE II domains of defining scope and purpose and clarity of presentation, and had the most fully met IOM\'s best practice standard for articulation of recommendations. However, only 1 urticaria CPG by NICE was identified as rigorously developed across all 3 appraisal tools.
The quality of urticaria CPGs in the last 5 years varied widely. Only the NICE urticaria guideline consistently demonstrated excellent quality, high trustworthiness, and low risk of bias. Use of a rigorous framework to rate certainty of evidence and grade strength of recommendation, involvement of methodologists, stakeholder engagement with external review, and clear guidance for updating can help improve the quality of future CPGs.

暂无摘要。

BACKGROUND: Allergic skin diseases are common in horses worldwide. The most common causes are insect bites and environmental allergens.
OBJECTIVE: To review the current literature and provide consensus on pathogenesis, diagnosis, treatment and prevention.
METHODS: The authors reviewed the literature up to November 2022. Results were presented at North America Veterinary Dermatology Forum (2021) and European Veterinary Dermatology Congress (2021). The report was available to member organisations of the World Association for Veterinary Dermatology for feedback.
CONCLUSIONS: Insect bite hypersensitivity (IBH) is the best characterised allergic skin disease. An immunoglobulin (Ig)E response against Culicoides salivary antigens is widely documented. Genetics and environmental factors play important roles. Tests with high sensitivity and specificity are lacking, and diagnosis of IBH is based on clinical signs, seasonality and response to insect control. Eosinophils, interleukin (IL)-5 and IL-31 are explored as therapeutic targets. Presently, the most effective treatment is insect avoidance. Existing evidence does not support allergen-specific immunotherapy (ASIT) using commercially available extracts of Culicoides. Hypersensitivity to environmental allergens (atopic dermatitis) is the next most common allergy. A role for IgE is supported by serological investigation, skin test studies and positive response to ASIT. Prospective, controlled, randomised studies are limited, and treatment relies largely on glucocorticoids, antihistamines and ASIT based on retrospective studies. Foods are known triggers for urticaria, yet their role in pruritic dermatitis is unknown. Recurrent urticaria is common in horses, yet our understanding is limited and focussed on IgE and T-helper 2 cell response. Prospective, controlled studies on treatments for urticaria are lacking. Glucocorticoids and antihistamines are primary reported treatments.
BACKGROUND: Les dermatoses allergiques sont courantes chez les chevaux dans le monde entier. Les causes les plus fréquentes sont les piqûres d\'insectes et les allergènes environnementaux.
OBJECTIVE: Examiner la littérature actuelle et établir un consensus sur la pathogénie, le diagnostic, le traitement et la prévention. MATÉRIELS ET MÉTHODES: Les auteurs ont passé en revue la littérature jusqu\'en novembre 2022. Les résultats ont été présentés au « North America Veterinary Dermatology Forum » (2021) et à l’« European Veterinary Dermatology Congress » (2021). Le rapport a été soumis organisations membres de l\'Association mondiale de dermatologie vétérinaire afin de recueillir leurs commentaires.
UNASSIGNED: L\'hypersensibilité aux piqûres d\'insectes (IBH) est l’affection cutanée allergique la mieux caractérisée. Une réponse médiée par les immunoglobulines (Ig)E contre les antigènes salivaires des Culicoides est largement documentée. Des facteurs génétique et les environnementaux jouent un rôle important. Des tests suffisamment sensible et spécifique font défaut, et le diagnostic de l\'IBH est fondé sur les signes cliniques, la saisonnalité et la réponse au contrôle des insectes. Les éosinophiles, l\'interleukine (IL)-5 et l\'IL-31 sont explorés comme cibles thérapeutiques. Actuellement, le traitement le plus efficace consiste en l’éviction parasitaire. Les données actuelles ne permettent pas de recommander l\'immunothérapie spécifique (ASIT) avec des extraits de culicoïdes disponibles dans le commerce. L\'hypersensibilité aux allergènes environnementaux (dermatite atopique) est le second type d’allergie le plus fréquent. Une implication des IgE est étayée par les tests sérologiques et cutanés et la réponse favorable à l\'ASIT. Les études prospectives, contrôlées et randomisées sont limitées et le traitement repose en grande partie sur les glucocorticoïdes, les antihistaminiques et l\'ASIT selon les données des études rétrospectives. Les aliments sont des déclencheurs connus de l\'urticaire, mais leur rôle dans les dermatites prurigineuses est inconnu. L\'urticaire récurrente est courante chez les chevaux, mais notre compréhension est limitée et axée sur la réponse des cellules IgE et T-helper 2. Des études prospectives contrôlées sur les traitements de l\'urticaire font défaut. Les glucocorticoïdes et les antihistaminiques sont les principaux traitements rapportés.
INTRODUCCIÓN: Las enfermedades alérgicas de la piel son comunes en los caballos en todo el mundo. Las causas más comunes son las picaduras de insectos y los alérgenos ambientales. OBJETIVOS: Revisar la literatura actual y brindar consenso sobre patogenia, diagnóstico, tratamiento y prevención. MATERIALES Y MÉTODOS: los autores revisaron la literatura hasta noviembre de 2022. Los resultados se presentaron en el Foro de Dermatología Veterinaria de América del Norte (2021) y el Congreso Europeo de Dermatología Veterinaria (2021). El informe estuvo disponible para las organizaciones miembros de la Asociación Mundial de Dermatología Veterinaria para recibir comentarios. CONCLUSIONES Y RELEVANCIA CLÍNICA: clínica- La hipersensibilidad a las picaduras de insectos (IBH) es la enfermedad alérgica de la piel mejor caracterizada. Una respuesta de inmunoglobulina (Ig)E contra antígenos salivales de Culicoides está ampliamente documentada. La genética y los factores ambientales juegan un papel importante. Faltan pruebas con alta sensibilidad y especificidad, y el diagnóstico de IBH se basa en los signos clínicos, la estacionalidad y la respuesta al control de insectos. Los eosinófilos, la interleucina (IL)-5 y la IL-31 se exploran como dianas terapéuticas. Actualmente, el tratamiento más efectivo es evitar los insectos. La evidencia existente no respalda la inmunoterapia específica de alérgenos (ASIT) con extractos de Culicoides disponibles comercialmente. La hipersensibilidad a los alérgenos ambientales (dermatitis atópica) es la siguiente alergia más común. El papel de la IgE está respaldado por la investigación serológica, los estudios de pruebas cutáneas y la respuesta positiva a ASIT. Los estudios prospectivos, controlados y al azarson limitados y el tratamiento se basa en gran medida en glucocorticoides, antihistamínicos y ASIT según estudios retrospectivos. Los alimentos son desencadenantes conocidos de la urticaria, pero se desconoce su papel en la dermatitis pruriginosa. La urticaria recurrente es común en los caballos, sin embargo, nuestra comprensión es limitada y se centra en la respuesta de las células IgE y T-helper 2. Faltan estudios prospectivos y controlados sobre tratamientos para la urticaria. Los glucocorticoides y los antihistamínicos son los principales tratamientos reportados. Actualmente, el tratamiento más efectivo es evitar los insectos. La evidencia existente no respalda la inmunoterapia específica de alérgenos (ASIT) con extractos de Culicoides disponibles comercialmente. La hipersensibilidad a los alérgenos ambientales (dermatitis atópica) es la siguiente alergia más común. El papel de la IgE está respaldado por la investigación serológica, los estudios de pruebas cutáneas y la respuesta positiva a ASIT. Los estudios prospectivos, controlados y al azar son limitados y el tratamiento se basa en gran medida en glucocorticoides, antihistamínicos y ASIT según estudios retrospectivos. Los alimentos son desencadenantes conocidos de la urticaria, pero se desconoce su papel en la dermatitis pruriginosa. La urticaria recurrente es común en los caballos, sin embargo, nuestra comprensión es limitada y se centra en la respuesta de las células IgE y T-helper 2. Faltan estudios prospectivos y controlados sobre tratamientos para la urticaria. Los glucocorticoides y los antihistamínicos son los principales tratamientos reportados.
UNASSIGNED: Allergische Hauterkrankungen kommen bei Pferden auf der ganzen Welt häufig vor. Die häufigsten Ursachen sind Insektenstiche und Umweltallergene.
UNASSIGNED: Das Ziel dieser Studie war die Durchführung einer Review der momentanen Literatur und Darstellung eines Konsenses in Bezug auf die Pathogenese, die Diagnose, die Therapie und die Vorbeugung.
UNASSIGNED: Die Autoren überprüften die Literatur bis in den November 2022. Die Ergebnisse wurden beim North American Veterinary Dermatology Forum (2021) und beim Europäischen Veterinärdermatologie Kongress (2021) präsentiert. Der Bericht wurde Mitgliedsorganisationen der World Association for Veterinary Dermatology für ein Feedback zur Verfügung gestellt.
UNASSIGNED: Die Insektenstich Hypersensibilität (IBH) ist die am besten beschriebene allergische Hauterkrankung. Eine Immunglobulin (Ig) E Antwort auf Culicoides Speichelallergene ist häufig beschrieben. Die Genetik und Umweltfaktoren spielen dabei eine wichtige Rolle. Es fehlen Tests mit hoher Sensibilität und Spezifität und die Diagnose von IBH basiert auf klinischen Zeichen, Saisonalität und Reaktion auf Insektenkontrolle. Eosinophile, Interleukin (IL)-5 und IL-31 werden als therapeutische Angriffspunkte untersucht. Zurzeit ist die Insektenvermeidung die am besten wirksame Therapie. Die bestehende Evidenz spricht nicht für eine Allergen-spezifische Immuntherapie (ASIT) mit kommerziell verfügbaren Culicoides Extrakten. Die Hypersensibilität auf Umweltallergene (Atopische Dermatitis) ist die zweithäufigste Allergie. Eine Rolle für IgE wird durch serologische Untersuchungen, Hautteststudien und positive Reaktionen auf ASIT gestärkt. Prospektive, kontrollierte, randomisierte Studien sind limitiert und die Behandlung stützt sich hauptsächlich auf Glukokortikoide, Antihistamine und ASIT basierend auf retrospektiven Studien. Futter stellen bekannte Auslöser für Urticaria dar, allerdings ist ihre Rolle bei der juckenden Dermatitis unbekannt. Wiederkehrende Urticaria treten bei Pferden häufig auf, unser Verständnis ist diesbezüglich aber limitiert und konzentriert sich auf Reaktionen von IgE und T2-Helferzellen. Prospektive kontrollierte Studien über die Behandlungen von Urticaria fehlen. Glukokortikoide und Antihistamine sind die am häufigsten beschriebenen Behandlungen.
背景: アレルギー性皮膚疾患は世界中の馬でよく見られる。主な原因は虫刺されや環境アレルゲンである。 目的: 本研究の目的は、 現在の文献をレビューし、病態、診断、治療、予防に関するコンセンサスを得ることであった。 材料と方法: 著者らは 2022 年 11 月までの文献をレビューした。結果は、North America Veterinary Dermatology Forum(2021年)およびEuropean Veterinary Dermatology Congress(2021年)で発表した。報告書は世界獣医皮膚科学会の会員団体に提供し、フィードバックを得た。 結論と臨床的関連性: 虫刺され過敏症(IBH)は、最も特徴的なアレルギー性皮膚疾患である。サシバエの唾液抗原に対する免疫グロブリン(Ig)E応答は広く報告されている。遺伝および環境因子が重要な役割を果たす。IBHの診断は、臨床症状、季節性、防虫への反応に基づいて行われる。好酸球、インターロイキン(IL)-5、IL-31が治療標的として探索されている。現在のところ、最も効果的な治療法は昆虫の忌避である。既存のエビデンスは、市販のサシバエ抽出物を用いたアレルゲン特異的免疫療法(ASIT)を支持しない。環境アレルゲンに対する過敏症(アトピー性皮膚炎)は、次に多いアレルギーである。IgEの役割は、血清学的調査、皮膚試験、およびASITに対する陽性反応によって裏付けられている。プロスペクティブな無作為化対照試験は限られており、治療は主にグルココルチコイド、抗ヒスタミン剤、レトロスペクティブな研究に基づくASITに頼っている。食品は蕁麻疹の誘因として知られているが、痒みのある皮膚炎におけるその役割は不明である。蕁麻疹の再発は馬によく見られるが、我々の理解は限られており、IgEとヘルパーT2細胞反応に焦点を当てている。蕁麻疹の治療法に関するプロスペクティブな対照試験は不足している。グルココルチコイドと抗ヒスタミン剤が主な治療法として報告されている.
背景: 过敏性皮肤病在世界各地的马中很常见。最常见的原因是昆虫叮咬和环境过敏原。 目的: 回顾现有达成共识的文献，就发病机制、诊断、治疗和预防。 材料和方法: 作者回顾了截至2022年11月的文献。研究结果在北美兽医皮肤病论坛(2021)和欧洲兽医皮肤病大会(2021)上公布。该报告可供世界兽医皮肤病学协会的成员组织反馈。 结论和临床相关性: 虫咬超敏反应(IBH)是最具特征的过敏性皮肤病。针对库蚊唾液抗原的免疫球蛋白(Ig)E反应已被广泛记录。遗传和环境因素起着重要作用。缺乏高灵敏度和特异性的测试，IBH的诊断是基于临床症状、季节性和对昆虫控制的反应。嗜酸性粒细胞、白细胞介素(IL)-5和IL-31被探索作为治疗靶点。目前，最有效的治疗方法是避开昆虫。现有证据不支持使用市售库蚊提取物的过敏原特异性免疫疗法(ASIT)。对环境过敏原过敏(特应性皮炎)是第二常见的过敏。血清学调查、皮肤试验研究和ASIT阳性反应支持了IgE的作用。前瞻性、对照、随机研究有限，治疗主要依赖于基于回顾性研究的糖皮质激素、抗组胺药和ASIT。食物是已知的荨麻疹诱因，但它们在瘙痒性皮炎中的作用尚不清楚。复发性荨麻疹在马中很常见，但我们的理解有限，主要集中在IgE和辅助T细胞2的反应上。缺乏关于荨麻疹治疗的前瞻性对照研究。糖皮质激素和抗组胺药是主要的治疗方法.
UNASSIGNED: Dermatopatias alérgicas são comuns em equinos em todo o mundo. As principais causas são picadas de insetos e alérgenos ambientais.
OBJECTIVE: Revisar a literatura atual e produzir um consenso sobre patogênese, diagnóstico, tratamento e prevenção. MATERIAIS E MÉTODOS: Os autores revisaram a literatura até novembro de 2022. Os resultados foram apresentados no North America Veterinary Dermatology Forum (2021) e no European Veterinary Dermatology Congress (2021). O relatório estava disponível para as organizações membro da World Association for Veterinary Dermatology para que dessem seu feedback. CONCLUSÕES E RELEVÂNCIA CLÍNICA: Hipersensibilidade a picada de insentos (IBH) é a dermatopatia alérgica melhor caracterizada. Resposta mediada por imunoglobulina (Ig)E contra antígenos salivares de Culicoides é amplamente documentada. Genética e fatores ambientais possuem participação importante. São poucos os testes com alta sensibilidade e especificidade, e o diagnóstico de IBH é baseado em sinais clínicos, sazonalidade e resposta ao controle de insetos. Eosinófilos, interleucina (IL)-5 e IL-31 estão sendo exploradas como alvos terapêuticos. Atualmente, o tratamento mais eficaz é evitar o contato com os insetos. As evidências existentes não corroboram com a utilização de imunoterapia alérgeno-específica (ASIT) utilizando extratos comerciais de Culicoides. Hipersensibilidade a alérgenos ambientais (dermatite atópica) é a segunda alergopatia mais comum. Investigação sorológica, testes cutâneos e resposta positiva à ASIT confirmam a participação de IgE. Estudos prospectivos placebo-controle randomisados são limitados e o tratamento é feito com glicocorticoides, antihistamínicos e ASIT baseado em estudos retrospectivos. Alimentos são gatilhos conhecidos para urticária, mas a sua participação em dermatopatias pruriginosas é desconhecida. Urticária recorrente é comum em equinos, apesar de o nosso conhecimento ser ainda limitado e focado em IgE e respostas de células T-helper 2. Faltam estudos prospectivos e controlados sobre tratamentos para urticária. Glicocorticoides e antihistamínicos são os principais tratamentos relatados.

This publication is the second part of the German-language S3 guideline on urticaria. It covers the management of urticaria and should be used together with Part 1 of the guideline on classification and diagnosis. This publication was prepared according to the criteria of the AWMF on the basis of the international English-language S3 guideline with special consideration of health system conditions in German-speaking countries. Chronic urticaria has a high impact on the quality of life and daily activities of patients. Therefore, if causal factors cannot be eliminated, effective symptomatic treatment is necessary. The recommended first-line treatment is to administer new generation, non-sedating H1 antihistamines. If the standard dose is not sufficiently effective, the dose should be increased up to fourfold. For patients who do not respond to this treatment, the second-line treatment in addition to antihistamines in the treatment algorithm is omalizumab and, if this treatment fails, ciclosporin. Other low-evidence therapeutic agents should only be used if all treatments in the treatment algorithm agreed upon by the guideline group fail. Both the benefit-risk profile and cost should be considered. Corticosteroids are not recommended for long-term treatment due to their inevitable severe side effects.

The lifetime prevalence of urticaria, a severe allergic disease, is almost 20%. It not only limits the quality of life of those affected, but also their general performance at work and in their daily activities. This publication is the first section of the Urticaria Guideline. It covers the classification and diagnosis of urticaria, taking into account the major advances in research into its causes, triggering factors and pathomechanisms. It also addresses strategies for the efficient diagnosis of the different subtypes of urticaria. This is crucial for individual, patient-oriented treatment, which is covered in the second part of the guideline, published separately. This German-language guideline was developed according to the criteria of the AWMF on the basis of the international English-language S3 guideline with special consideration of health system characteristics in the German-speaking countries. This first part of the guideline describes the classification of urticaria, distinguishing spontaneously occurring wheals (hives) and angioedema from forms of urticaria with inducible symptoms. Urticaria is defined as sudden onset of wheals, angioedema, or both, but is to be distinguished from conditions in which wheals occur as a short-term symptom, such as anaphylaxis. The diagnosis is based on (a limited number of) laboratory tests, but especially on medical history. In addition, validated instruments are available to measure the severity, activity and course of the disease.

Urticaria is a heterogeneous inflammatory disorder that can be acute or chronic and is defined by the appearance of wheals, angioedema, or both. Very recently, the newest update and revision of the international European Academy of Allergy and Clinical Immunology/Global Allergy and Asthma European Network/European Dermatology Forum/Asia Pacific Association of Allergy Asthma Clinical Immunology guideline for the definition, classification, diagnosis, and management of urticaria was published. It aims to help primary care physicians and specialists in the management of their patients with urticaria. The guideline applied the Grading of Recommendations Assessment Development and Evaluations approach to developing consensus recommendations. These recommendations were then discussed in a Delphi conference that included more than 250 specialists in the field, and they are endorsed by more than 50 international societies. Here, we highlight changes from previous versions of the international urticaria guideline and their impact on clinical practice.

BACKGROUND: Problems in the definition and classification of angioedema, leading to difficulties in its diagnosis and treatment, have been identified; therefore, an improvement in the current classification of angioedema is required.
OBJECTIVE: The aim of this study was to propose a practical classification of angioedema without wheals that helps to establish a differential diagnosis and take appropriate therapeutic decisions.
METHODS: An initial proposal of classification of angioedema without wheals was agreed by a scientific committee of experts and was subsequently validated by a panel of experts by means of consensus based on the Delphi methodology. Forty-five items on the classification, diagnosis, and treatment of angioedema without wheals were proposed for the survey.
RESULTS: Most items (93.8%) were agreed after two rounds. All panelists agreed with the proposed classification, as well as with most of the clinical and treatment characteristics. The angioedema without wheals classification established three groups: histamine-mediated, bradykinin-mediated, and unknown mechanism angioedema. The clinical characteristics of the proposed types of angioedema were also agreed, except for the allergic histamine-mediated and unknown mechanism angioedema, which generated debate. Regarding treatments, although there was broad agreement with the proposed items, a lack of knowledge about some treatments in this pathology was observed.
CONCLUSIONS: The proposed classification of angioedema without wheals was accepted with a high degree of agreement; however, knowledge of available treatments needs to be increased and the definition of angioedema of unknown mechanism needs to be improved.

Objectives  Anaphylaxis is an acute, life-threatening immediate allergic reaction caused by the sudden systemic release of mediators from mast cells. This study aims to assess the current practice of emergency management of children and adults diagnosed with anaphylaxis at the Royal Hospital, Muscat, Oman, in line with the National Institute for Health and Clinical Excellence (NICE) guidelines.  Methods This is an observational retrospective study of all anaphylaxis cases seen at the emergency department (ED) from January 2013 to January 2018 and compared with the management of anaphylaxis in the ED as per the NICE guidelines. Inclusion criteria were all patients, children (age 16 and below), and adults diagnosed with anaphylaxis based on the World Allergy Organization (WAO) criteria. Exclusion criteria are all cases labeled as anaphylaxis that did not match the WAO criteria for anaphylaxis. Results Of 100 patients with a preliminary diagnosis of anaphylaxis, 49 patients (49%) were true-anaphylaxis cases based on the WAO definition 16 were children (age 16 years and below), and 33 were adults ( age 16 years and above). The other 51 patients (51%) with misdiagnosed anaphylaxis were later diagnosed with spontaneous urticaria, septic shock, vocal cord dysfunction, severe asthma, and anxiety attack. All 49 patients with true-anaphylaxis appropriately received adrenaline intramuscularly at the ED. All 16 children were admitted, seen by an allergist, and received an adrenaline auto-injector when indicated. Only 5 of the 33 adults were admitted and seen by an allergist, and 4 of those required an adrenaline auto-injector upon discharge. The remaining 28 adults were discharged from the ED, and only 3 of these were referred to the allergist. None received an adrenaline auto-injector upon discharge from the ED, and no mention in the ED notes on patient education regarding allergen avoidance. Conclusion Third of the patients who presented to ED were children (<16 years), and two third were adults. Insect venom was the main reason for anaphylaxis in both age groups. There was an underutilization of adrenaline auto-injector prescriptions for adult patients. This could be very well improved by disseminating policies and guidelines to adult physicians.