title: [Sting challenge: indications and execution].
abstract: BACKGROUND
  Venom immunotherapy (VIT) is a highly effective treatment for Hymenoptera venom allergy. However, VIT treatment may fail to protect against systemic reactions. Many in vitro parameters as well as skin test reactivity change during the course of VIT; however, similar to the pre-treatment situation, there is no in vitro parameter, which reliably indicates the clinical reactivity of a sensitized patient. Sting challenge with the culprit insect is the only tool which reveals clinical reactivity.
  
  
  OBJECTIVE
  To define the indications, contraindications and performance of sting challenge tests.
  
  
  METHODS
  Review of the literature.
  
  
  RESULTS
  Sting challenge tests are not recommended for individuals who are not being treated with VIT, and are also not recommended as a routine diagnostic method for patients who have stopped VIT. Indications of sting challenge are identification of patients who are not protected, and quality of life issues. Major contraindications of sting challenge are repeated side effects or a field sting reaction during maintenance VIT, and unstable medical disease. Risk factors for treatment failure are mastocytosis, bee venom allergy, repeated side effects of VIT, and ACE inhibitors. Protection rate is significantly better in patients who are treated with elevated venom dose, with double VIT, and longer treatment duration.
  
  
  CONCLUSIONS
  For the majority of patients quality of life will significantly improve after tolerated sting challenge. A sting challenge test is particularly important in those patients who are at increased risk due their increased risk of treatment failure. If in patients with risk factors for treatment failure, VIT is done with elevated dose or if no risk factors are present, a sting challenge may not be needed. VIT with an elevated dose may prevent or correct treatment failure.
authors.affiliation: Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, Frauenlobstr. 9-11, 80337, München, Deutschland, Franziska.Rueff@med.uni-muenchen.de.
authors.forename: F
authors.initials: F
authors.lastname: Ruëff
authors.forename: B
authors.initials: B
authors.lastname: Przybilla
mesh_terms: D000818:Animals; D000888:Antibodies, Anti-Idiotypic / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D001514:Bee Venoms / Q000276:immunology / Q000627:therapeutic use*; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007118:Immunoassay / Q000379:methods*; D007299:Insect Bites and Stings / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy*; D000069444:Omalizumab; D016896:Treatment Outcome; D014862:Wasp Venoms / Q000276:immunology / Q000627:therapeutic use*
chemical_list: D000888:Antibodies, Anti-Idiotypic; D061067:Antibodies, Monoclonal, Humanized; D001514:Bee Venoms; D014862:Wasp Venoms; D000069444:Omalizumab