title: Utility of laboratory testing for the diagnosis of Hymenoptera venom allergy.
abstract: BACKGROUND
  A diagnosis of Hymenoptera venom allergy is based on clinical history and the results of skin tests and/or laboratory methods.
  
  
  OBJECTIVE
  To analyze the utility of available laboratory tests in diagnosing Hymenoptera venom allergy.
  
  
  METHODS
  Ninety-five patients with Hymenoptera venom allergy with a history of bee (35) or wasp (60) anaphylactic sting reaction and positive skin test with bee or wasp venom were included in this analysis. Specific immunoglobulin E (to bee venom extract, wasp venom extract, available recombinant molecules, and a basophil activation test with venom extracts were assessed in all the patients. Test sensitivity and specificity were calculated by using standard threshold values; then, receiver operating characteristic curve analysis was performed to compute optimal threshold values. Also, statistical analysis of the utility of different combinations of laboratory tests was performed.
  
  
  RESULTS
  The optimal threshold values were revealed to be the following: 1.0 kIU/L for bee venom extract (sensitivity, 97.14%; specificity, 100%), 0.35 kIU/L for rApi m 1 (sensitivity, 68.57%; specificity, 100%), 1.22 kIU/L for wasp venom extract (sensitivity, 88.33%; specificity, 95.45%), 0.7 kIU/L for rVes v 5 (sensitivity, 86.67%; specificity, 95.45%), 1.0 kIU/L for rVes v 1 (sensitivity, 56.67%; specificity, 95.45%), 6.5% for basophil activation test with bee venom extract (sensitivity, 80%; specificity, 95.45%), and 4.5% for basophil activation test with wasp venom extract (sensitivity, 91.53%; specificity, 95.45%). The best test combinations were found to be the following: bee venom extract plus rApi m 1 (sensitivity, 97.14%; specificity, 95.45%) in bee and either wasp venom extract plus rVes v 5, or rVes v 5 plus rVes v 1 (both sensitivity, 98.33%; specificity, 95.45%) in patients with wasp venom allergy.
  
  
  CONCLUSIONS
  Our analysis confirmed that currently used laboratory tests represent effective tools in diagnosing Hymenoptera venom allergy. Moreover, our probabilistic approach offered another way to interpret concrete values of laboratory test results and opened possible direction on how to optimize the laboratory diagnostic procedure.
authors.affiliation: Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
authors.forename: Martina
authors.initials: M
authors.lastname: Vachová
authors.forename: Petr
authors.initials: P
authors.lastname: Panzner
authors.forename: Ivana
authors.initials: I
authors.lastname: Malkusová
authors.forename: Jana
authors.initials: J
authors.lastname: Hanzlíková
authors.forename: Tomáš
authors.initials: T
authors.lastname: Vlas
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000175:diagnosis*; D000818:Animals; D001180:Arthropod Venoms / Q000276:immunology*; D001491:Basophils; D001514:Bee Venoms / Q000276:immunology; D019411:Clinical Laboratory Techniques / Q000379:methods*; D006801:Humans; D006927:Hymenoptera; D006967:Hypersensitivity / Q000175:diagnosis*; D007073:Immunoglobulin E / Q000032:analysis / Q000276:immunology; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014862:Wasp Venoms / Q000276:immunology
chemical_list: D001180:Arthropod Venoms; D001514:Bee Venoms; D014862:Wasp Venoms; D007073:Immunoglobulin E