Diagnostic methods for insect sting allergy.
OBJECTIVE
This review overviews advances from mid-2002 to the present in the validation and performance methods used in the diagnosis of Hymenoptera venom-induced immediate-type hypersensitivity.


RESULTS
The general diagnostic algorithm for insect sting allergy is initially discussed with an examination of the AAAAI's 2003 revised practice parameter guidelines. Changes as a result of a greater recognition of skin test negative systemic reactors include repeat analysis of all testing and acceptance of serology as a complementary diagnostic test to the skin test. Original data examining concordance of venom-specific IgE results produced by the second-generation Pharmacia CAP System with the Johns Hopkins University radioallergosorbent test are presented. Diagnostic performance of honeybee venom-specific IgE assays used in clinical laboratories in North America is discussed using data from the Diagnostic Allergy Proficiency Survey conducted by the College of American Pathologists. Validity of venom-specific IgE antibody in postmortem blood specimens is demonstrated. The utility of alternative in-vivo (provocation) and in-vitro (basophil-based) diagnostic testing methods is critiqued.


CONCLUSIONS
This overview supports the following conclusions. Improved practice parameter guidelines include serology and skin test as complementary in supporting a positive clinical history during the diagnostic process. Data are provided which support the analytical performance of commercially available venom-specific IgE antibody serology-based assays. Intentional sting challenge in-vivo provocation, in-vitro basophil flow cytometry (CD63, CD203c) based assays, and in-vitro basophil histamine and sulfidoleukotriene release assays have their utility in the study of difficult diagnostic cases, but their use will remain as supplementary, secondary diagnostic tests.
Hamilton
Robert G
RG
Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA. rhamilto@jhmi.edu
D000818:Animals; D001491:Basophils / Q000166:cytology / Q000276:immunology; D001514:Bee Venoms / Q000276:immunology; D003429:Cross Reactions / Q000276:immunology; D006801:Humans; D006927:Hymenoptera / Q000276:immunology; D006969:Hypersensitivity, Immediate / Q000175:diagnosis* / Q000276:immunology; D007118:Immunoassay; D007073:Immunoglobulin E / Q000097:blood; D007299:Insect Bites and Stings / Q000276:immunology*; D012882:Skin Tests
D001514:Bee Venoms; D007073:Immunoglobulin E