title: Inconsistent results of diagnostic tools hamper the differentiation between bee and vespid venom allergy.
abstract: BACKGROUND
  Double sensitization (DS) to bee and vespid venom is frequently observed in the diagnosis of hymenoptera venom allergy, but clinically relevant DS is rare. Therefore it is sophisticated to choose the relevant venom for specific immunotherapy and overtreatment with both venoms may occur. We aimed to compare currently available routine diagnostic tests as well as experimental tests to identify the most accurate diagnostic tool.
  
  
  METHODS
  117 patients with a history of a bee or vespid allergy were included in the study. Initially, IgE determination by the ImmunoCAP, by the Immulite, and by the ADVIA Centaur, as well as the intradermal test (IDT) and the basophil activation test (BAT) were performed. In 72 CAP double positive patients, individual IgE patterns were determined by western blot inhibition and component resolved diagnosis (CRD) with rApi m 1, nVes v 1, and nVes v 5.
  
  
  RESULTS
  Among 117 patients, DS was observed in 63.7% by the Immulite, in 61.5% by the CAP, in 47.9% by the IDT, in 20.5% by the ADVIA, and in 17.1% by the BAT. In CAP double positive patients, western blot inhibition revealed CCD-based DS in 50.8%, and the CRD showed 41.7% of patients with true DS. Generally, agreement between the tests was only fair and inconsistent results were common.
  
  
  CONCLUSIONS
  BAT, CRD, and ADVIA showed a low rate of DS. However, the rate of DS is higher than expected by personal history, indicating that the matter of clinical relevance is still not solved even by novel tests. Furthermore, the lack of agreement between these tests makes it difficult to distinguish between bee and vespid venom allergy. At present, no routinely employed test can be regarded as gold standard to find the clinically relevant sensitization.
authors.affiliation: Division of Environmental Dermatology and Venerology, Department of Dermatology, Medical University of Graz, Graz, Austria. gunter.sturm@medunigraz.at
authors.forename: Gunter J
authors.initials: GJ
authors.lastname: Sturm
authors.forename: Chunsheng
authors.initials: C
authors.lastname: Jin
authors.forename: Bettina
authors.initials: B
authors.lastname: Kranzelbinder
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hemmer
authors.forename: Eva M
authors.initials: EM
authors.lastname: Sturm
authors.forename: Antonia
authors.initials: A
authors.lastname: Griesbacher
authors.forename: Akos
authors.initials: A
authors.lastname: Heinemann
authors.forename: Jutta
authors.initials: J
authors.lastname: Vollmann
authors.forename: Friedrich
authors.initials: F
authors.lastname: Altmann
authors.forename: Karl
authors.initials: K
authors.lastname: Crailsheim
authors.forename: Margarete
authors.initials: M
authors.lastname: Focke
authors.forename: Werner
authors.initials: W
authors.lastname: Aberer
mesh_terms: D000328:Adult; D001514:Bee Venoms / Q000633:toxicity*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D014862:Wasp Venoms / Q000633:toxicity*
chemical_list: D001514:Bee Venoms; D014862:Wasp Venoms