title: Simplification of intradermal skin testing in Hymenoptera venom allergic children.
abstract: The direct comparison between children and adults with Hymenoptera venom anaphylaxis (HVA) has never been extensively reported. Severe HVA with IgE-documented mechanism is the recommendation for venom immunotherapy, regardless of age.
  
  
  
  To determine the differences in the basic diagnostic profile between children and adults with severe HVA and its practical implications.
  
  
  
  We reviewed the medical records of 91 children and 121 adults.
  
  
  
  Bee venom allergy was exposure dependent, regardless of age (P < .001). Atopy was more common in children (P = .01), whereas cardiovascular comorbidities were present almost exclusively in adults (P = .001). In the bee venom allergic group, specific IgE levels were significantly higher in children (29.5 kUA/L; interquartile range, 11.30-66.30 kUA/L) compared with adults (5.10 kUA/L; interquartile range, 2.03-8.30 kUA/L) (P < .001). Specific IgE levels for culprit insect venom were higher in bee venom allergic children compared with the wasp venom allergic children (P < .001). In adults, intradermal tests revealed higher sensitivity, accompanied by larger area of skin reactions, regardless of type of venom. At concentrations lower than 0.1 μg/mL, 16% of wasp venom allergic children and 39% of bee venom allergic children had positive intradermal test results. The median tryptase level was significantly higher in adults than in children for the entire study group (P = .002), as well as in bee (P = .002) and wasp venom allergic groups (P = .049).
  
  
  
  The basic diagnostic profile in severe HVA reactors is age dependent. Lower skin test reactivity to culprit venom in children may have practical application in starting the intradermal test procedure with higher venom concentrations.
authors.affiliation: Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Cichocka-Jarosz
authors.affiliation: Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland. Electronic address: marcin.stobiecki@uj.edu.pl.
authors.forename: Marcin
authors.initials: M
authors.lastname: Stobiecki
authors.affiliation: Dziupla Statistical Analysis, Krakow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Brzyski
authors.affiliation: Department of Clinical Biochemistry, University Children's Hospital, and Faculty of Medicine, Jagiellonian University, Krakow, Poland.
authors.forename: Iwona
authors.initials: I
authors.lastname: Rogatko
authors.affiliation: Department of Internal Medicine, Wrocław Medical University, Wrocław, Poland.
authors.forename: Marita
authors.initials: M
authors.lastname: Nittner-Marszalska
authors.affiliation: Department of Clinical Biochemistry, University Children's Hospital, and Faculty of Medicine, Jagiellonian University, Krakow, Poland.
authors.forename: Krystyna
authors.initials: K
authors.lastname: Sztefko
authors.affiliation: Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Czarnobilska
authors.affiliation: Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Lis
authors.affiliation: Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, New York, New York.
authors.forename: Anna
authors.initials: A
authors.lastname: Nowak-Węgrzyn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000485:Allergens / Q000276:immunology*; D000707:Anaphylaxis / Q000175:diagnosis* / Q000276:immunology*; D000818:Animals; D001180:Arthropod Venoms / Q000009:adverse effects*; D001514:Bee Venoms; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006228:Hand Deformities, Congenital; D006801:Humans; D006927:Hymenoptera / Q000276:immunology*; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D007299:Insect Bites and Stings; D007428:Intradermal Tests / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D010855:Pierre Robin Syndrome; D012189:Retrospective Studies; D014862:Wasp Venoms; D055815:Young Adult
chemical_list: D000485:Allergens; D001180:Arthropod Venoms; D001514:Bee Venoms; D014862:Wasp Venoms; D007073:Immunoglobulin E