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14 patients clinically hypersensitive to vespid sting by history, 6 patients with large local reactions and 10 control subjects were skin tested with serial two- and tenfold dilutions of venom and whole-body extract of yellow jacket, wasp, and white-faced hornet antigens. Radioallergosorbent test determinations with the same antigens were also made. Determination of minimal reactive dose by skin testing distinguished control and hypersensitive patients groups for all three antigens using either venom or whole body extract. Yellow jacket venom skin testing detected 12 of 14 patients considered clinically hypersensitive. This was not the case with the other two venoms, possibly because most of the patients were yellow jacket sensitive, or any of the whole-body extracts. The Radioallergosorbent test was less useful than venom skin testing in detecting patients considered clinically sensitive.

Summary and Conclusions Twenty-four persons with extreme allergy toward yellow jacket wasp stings were immunized safely with single, yearly, subcutaneous repositories of emulsified heterologous venom from the polistes wasp, there being no significant adverse developments on treatment day and no longterm sequelae such as abscess, cyst or neoplasm in the next 3 to 4 years. By contrast, control groups with identical allergy exhibited two adverse responses among 111 single-visit courses of fluid venom prepared from the homologous wasp or from polistes wasps. Effectiveness of therapy was judged by the clinical response to later stingings, of which 60 took place by plan in the hospital and four in the field by accident. Aside from trivial focal developments in 12 instances, only two significant adverse episodes were engendered, one in a repository-treated man and one after an immunization with homologous fluid venom. Subsequent repetition of the challenge found both men fully tolerant, one having taken a booster of fluid polistes venom in the meantime while the second merely rested. It was deduced that factors other than specificity differences in the two immunizing venoms probably had been responsible for the clinical failure after repository. The 64 challenges involved one to four insects and post-treatment periods that ranged from 9 days to 21 weeks for courses of fluid venom, and from 15 to 27 weeks for depot therapy. All but a few of the sting tested subjects have been transferred to intermittent sting-therapy to maintain their demonstrated immunity and are now receiving 2-min stingings from 3 to 4 wasps—polistes in cold months, yellow jacket wasps in summer—at intervals approaching a year. Threshold tests of skin and eye may afford a clue, before immunization, to the patient's tolerance for injected venom. After therapy, there is a small but statistically significant elevation in requirement, due to induced blocking antibody. As to the indication for specific prophylaxis in sting allergy, probably only those victims whose next encounter threatens disaster merit immunization, in view of the implied long-term risk of using foreign proteins parenterally. Obviously, only the simplest preparations and the smallest effective amounts are justified in any case, viz., venom as opposed to whole body extracts, and a single annual treatment as opposed to weekly and monthly injections over protracted periods.

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