Don't Perform Hymenoptera Skin Tests on Patients Without Previous Systemic Reactions

Summary and Comment |
July 3, 2014

Don't Perform Hymenoptera Skin Tests on Patients Without Previous Systemic Reactions

  1. David J. Amrol, MD

Positive skin tests don't predict severe reactions to sting challenges.

  1. David J. Amrol, MD

Almost all adults have been stung by Hymenoptera (honey bees, wasps, hornets, or yellow jackets) at some point. Fewer than 7% of people who are stung experience systemic sting reactions (SSRs; generalized hives, angioedema, or anaphylactic symptoms), and about a quarter have large local reactions (LLRs). However, specific IgE antibodies to Hymenoptera venoms can be detected in 40% of the general population, so most sensitized individuals are not allergic to Hymenoptera venoms. Venom immunotherapy is indicated only for systemic reactions and is not recommended for LLRs or asymptomatic sensitization.

In an Austrian study, 94 people who had positive skin tests and specific IgE antibodies to Hymenoptera venom but had never experienced SSRs underwent live sting challenges. Forty-one patients had LLRs, and five patients had SSRs. One year later, eight intrepid patients underwent second sting challenges, and none experienced SSRs.

Comment

Patients often ask me for Hymenoptera skin testing because they have family histories of reactions or have had personal large local reactions. This study reaffirms current guidelines that state Hymenoptera skin testing should be performed only in patients who have experienced systemic reactions; if skin testing is positive in such patients, venom immunotherapy should be offered (Allergy 2005; 60:1339). Children younger than 16 typically outgrow mild systemic sting reactions, so in pediatric patients, testing should be performed only in those with severe SSRs.

Editor Disclosures at Time of Publication

  • Disclosures for David J. Amrol, MD at time of publication Equity Abbott; AbbieVie; Express Scripts; Johnson and Johnson; Novartis; Pfizer; United Health Leadership positions in professional societies Allergy Society of South Carolina (Past President)

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