title: Venom allergy testing: is a graded approach necessary?
abstract: BACKGROUND
  Many institutions recommend a stepwise approach to intradermal testing for venom allergy. This is costly and uncomfortable for the patient. The rationale for this approach is the risk of potential adverse reactions to testing with the maximal dose alone.
  
  
  OBJECTIVE
  To evaluate the safety of a single-step approach to venom allergy testing.
  
  
  METHODS
  The authors retrospectively reviewed the charts of 300 consecutive patients with suspected hymenoptera venom allergy based on history who underwent venom allergy testing in a single allergist's clinic where a single-step protocol had been adopted. All patients had positive skin test reaction to at least 1 hymenoptera venom. Charts were reviewed for testing protocol used, results of testing, and reported immediate and delayed adverse reactions to testing.
  
  
  RESULTS
  All patients underwent testing with an identical single-step protocol with an intradermal dose of 0.02 mL of a 1.0-μg/mL concentration of each of the 5 commercially available vespid and bee venoms. Only 1 patient reported an adverse reaction to testing, which was delayed until the morning after his visit. There were no immediate adverse reactions. The patient who had the delayed reaction was successfully started on venom immunotherapy subsequent to his reaction.
  
  
  CONCLUSIONS
  A single-step venom allergy intradermal testing protocol with a 1.0-μg/mL concentration of commercially available extracts is a safe option, which, if adopted into practice, could lead to more streamlined care for patients and cost savings for the medical system.
authors.affiliation: Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. Electronic address: jaclyn.quirt@medportal.ca.
authors.forename: Jaclyn A
authors.initials: JA
authors.lastname: Quirt
authors.affiliation: Neuroscience, Faculty of Biology, Physiology and Psychology, McGill University, Montreal, Quebec, Canada.
authors.forename: Xia
authors.initials: X
authors.lastname: Wen
authors.affiliation: Centric Health, Toronto, Ontario, Canada; Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kim
authors.affiliation: El Carmelo, Granada, Spain; Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Angel Jimenez
authors.initials: AJ
authors.lastname: Herrero
authors.affiliation: Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada.
authors.forename: Harold L
authors.initials: HL
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000485:Allergens / Q000276:immunology*; D000818:Animals; D001514:Bee Venoms / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis* / Q000276:immunology; D007428:Intradermal Tests; D008297:Male; D008875:Middle Aged; D014862:Wasp Venoms / Q000276:immunology*; D055815:Young Adult
chemical_list: D000485:Allergens; D001514:Bee Venoms; D014862:Wasp Venoms