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 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.


CONCLUSIONS
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.
van Halteren
H K
HK
Department of Internal Medicine, Eemland Hospital, Amersfoort, The Netherlands.
van der Linden
P W
PW
Burgers
S A
SA
Bartelink
A K
AK
D000328:Adult; D000707:Anaphylaxis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D000818:Animals; D001514:Bee Venoms / Q000627:therapeutic use; D001516:Bees / Q000276:immunology*; D005260:Female; D006801:Humans; D007299:Insect Bites and Stings / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D014862:Wasp Venoms / Q000627:therapeutic use; D014863:Wasps / Q000276:immunology*
D001514:Bee Venoms; D014862:Wasp Venoms