Hymenoptera sting challenge of 348 patients: Relation to subsequent field stings

BACKGROUND: Patients with a history of a serious anaphylactic reaction after a Hymenoptera sting are usually given venom immunotherapy. Because the natural history of Hymenoptera sting anaphylaxis is often of a declining severity, there is a chance of overtreatment. OBJECTIVE: Identification of pati...

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Bibliographic Details
Published in:Journal of allergy and clinical immunology 1996-05, Vol.97 (5), p.1058-1063
Main Authors: van Halteren, Henk K., van der Linden, Peter-Willem G., Burgers, Sjaak A., Bartelink, Anton K.M.
Format: Article
Language:English
Subjects:
Adult
anaphylaxis
Anaphylaxis - diagnosis
Anaphylaxis - etiology
Anaphylaxis - therapy
Animals
Bee Venoms - therapeutic use
Bees - immunology
Biological and medical sciences
Female
Humans
Hymenoptera
Immunopathology
immunotherapy
Immunotherapy (general aspects)
Insect Bites and Stings - diagnosis
Insect Bites and Stings - etiology
Insect Bites and Stings - therapy
Male
Medical sciences
Middle Aged
Predictive Value of Tests
Sting challenge
Wasp Venoms - therapeutic use
Wasps - immunology
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Summary:BACKGROUND: Patients with a history of a serious anaphylactic reaction after a Hymenoptera sting are usually given venom immunotherapy. Because the natural history of Hymenoptera sting anaphylaxis is often of a declining severity, there is a chance of overtreatment. OBJECTIVE: Identification of patients at risk for a future anaphylactic reaction may reduce the number of patients who need venom immunotherapy. METHODS: We investigated the relation between the grade of hypersensitivity to an in-hospital sting challenge and the reaction to a subsequent accidental field sting. From 1982 through 1992, 348 patients with mild or no symptoms after a sting challenge were not given venom immunotherapy. All patients were asked by letter whether they had experienced a subsequent field sting. In case of a sting, the severity of the reaction was further evaluated. RESULTS: Information could be obtained from 327 patients: 129 had been re-stung, and 110 of them had only had a local reaction. Thirteen patients had experienced mild systemic symptoms, and six patients had experienced serious manifestations. In two of the latter group hypotension was observed. CONCLUSION: In 95% of patients with a previous anaphylactic reaction, the result of the in-hospital sting challenge provided a good prediction of tolerance to a subsequent Hymenoptera field sting. (J A LLERGY C LIN I MMUNOL 1996;97:1058-63.)
ISSN:0091-6749
1097-6825
DOI:10.1016/S0091-6749(96)70258-0