title: The value of an in-hospital insect sting challenge as a criterion for application or omission of venom immunotherapy.
abstract: BACKGROUND
  Venom immunotherapy is a generally accepted treatment for serious allergy to bee and yellow jacket venom. However, it is not precisely known to whom venom immunotherapy should be offered.
  
  
  OBJECTIVE
  The purpose of this study was to determine whether an in-hospital insect sting challenge (IHC) can be used as a criterion for application or omission of venom immunotherapy.
  
  
  METHODS
  An IHC was carried out in a group of 479 patients (136 sensitized to bee venom and 343 sensitized to yellow jacket venom). The patients with a negative IHC response were interviewed about their experience with subsequent stings under natural circumstances.
  
  
  RESULTS
  A total of 76 of 136 bee-sensitized patients (56%) and 284 of 343 yellow jacket-sensitized patients (83%) had a negative IHC response. All of the patients who had a systemic reaction after the IHC were advised to receive venom immunotherapy. The success rate of this therapy was 96.4% for patients allergic to bee venom (54 of 56) and 91.4% for patients allergic to yellow jacket venom (53 of 58). Of a total of 76 bee-sensitized patients with negative IHC responses, 41 were subsequently stung in the field; six patients had a mild (Mueller grade I) systemic reaction (14.6%). Of a total of 284 yellow jacket-sensitized with negative IHC responses, 127 were subsequently stung in the field; nine patients had a mild (Mueller grades I and II) systemic reaction (7.1%), and four patients had a severe (Mueller grades III and IV) systemic reaction (3.1%). Without an IHC as a selection criterion for venom immunotherapy, the percentage of patients unnecessarily treated was calculated to be 48% for bee venom-sensitized patients and 74% for yellow jacket-sensitized patients. However, with a negative test IHC response as a selection criterion for the omission of venom immunotherapy, 14.6% of the bee venom-sensitized patients and 10.2% of the yellow jacket-sensitized patients were proven to be at risk for systemic reactions on subsequent field stings.
  
  
  CONCLUSIONS
  Venom immunotherapy with bee or yellow jacket venom is justifiable only after a positive response to an IHC is observed.
authors.affiliation: Elkerliek Hospital, Helmond, The Netherlands.
authors.forename: P J
authors.initials: PJ
authors.lastname: Blaauw
authors.forename: O L
authors.initials: OL
authors.lastname: Smithuis
authors.forename: A R
authors.initials: AR
authors.lastname: Elbers
mesh_terms: D000328:Adult; D000818:Animals; D001514:Bee Venoms / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016233:Immunotherapy, Active; D007299:Insect Bites and Stings / Q000209:etiology / Q000276:immunology / Q000628:therapy*; D008297:Male; D010343:Patient Admission; D014862:Wasp Venoms / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*
chemical_list: D001514:Bee Venoms; D014862:Wasp Venoms