title: Dialyzed venom skin tests for identifying yellow jacket-allergic patients not detected using standard venom.
abstract: BACKGROUND
  The chance of a nonspecific intradermal skin test response at venom concentrations greater than 1.0 microg/mL limits the diagnostic range and can interfere with the diagnosis of some affected patients.
  
  
  OBJECTIVE
  To compare the diagnostic ranges and clinical detection rates of skin tests using dialyzed yellow jacket venom (DYJV) and undialyzed YJV (UYJV), particularly in patients who have had negative venom skin test results.
  
  
  METHODS
  Both DYJV and UYJV from the same original lot were diluted from 100 microg/mL to skin test concentrations of 0.01, 0.1, 1.0, 3.0, and 10 microg/mL. Participants included 10 nonallergic controls, 20 patients with a positive history and positive skin test results using UYJV, and 24 patients with a positive history but negative skin test results using UYJV (17 of whom had a positive IgE anti-YJV serology).
  
  
  RESULTS
  Dialyzed venom skin test results were positive at 10 microg/mL or less in 79% of patients with a positive history but negative skin test reactions using UYJV. The dialyzed venom skin test results showed a half-log shift to the left from the undialyzed venom results in linear regression analysis, indicating a greater detection rate with skin tests using DYJV. Results of skin tests with dialyzed venom were positive in 3 of 4 patients who had negative undialyzed venom skin test results and who experienced a systemic reaction to challenge stings.
  
  
  CONCLUSIONS
  The DYJV improves the ability of skin tests to detect yellow jacket allergy and should be subject to further study.
authors.affiliation: Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland 21224, USA. dgolden1@jhmi.edu
authors.forename: David B K
authors.initials: DB
authors.lastname: Golden
authors.forename: Denise
authors.initials: D
authors.lastname: Kelly
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hamilton
authors.forename: Nae-Yuh
authors.initials: NY
authors.lastname: Wang
authors.forename: Anne
authors.initials: A
authors.lastname: Kagey-Sobotka
mesh_terms: D000818:Animals; D003956:Dialysis; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000175:diagnosis* / Q000276:immunology; D007299:Insect Bites and Stings / Q000175:diagnosis* / Q000276:immunology; D012882:Skin Tests / Q000379:methods*; D014862:Wasp Venoms / Q000737:chemistry / Q000276:immunology; D014863:Wasps / Q000276:immunology*
chemical_list: D014862:Wasp Venoms