The value of an in-hospital insect sting challenge as a criterion for application or omission of venom immunotherapy

Clinical features and severity grading of anaphylaxis

“…Various modifications of the widely used Mueller system have considered gastrointestinal manifestations to be less serious than those affecting the respiratory system, and equivalent in importance to angioedema. 5,6,8,9,13,15,16 One of these studies found modified Mueller grades to correlate well with epinephrine administration in the setting of insect venom allergy. 13 Other systems do not assign any importance to gastrointestinal features.…”

“…Although reaction severity in an individual may fluctuate over time, studies of insect venom allergy have suggested that prior maximal reaction severity may be used to predict subsequent reaction severity (subsequent reactions being of similar or lesser severity) and thus select people who are most likely to benefit from immunotherapy and to carry self-administered epinephrine. 8,9,13 Severity grading and analysis of the baseline characteristics that determine reaction severity are also important components of anaphylaxis research. A prospective evaluation of this system in terms of ease and accuracy of application, and as a guide for subsequent therapy, is therefore warranted.…”

“…Ages ranged from 0 to 96 years, with a median of 29 years (17 aged < 1 year, 237 aged 1 to 14 years, 421 aged 14 to 35 years, and 474 aged >35). In 118 (10%) a history of 1 or more cardiovascular diseases were recorded (hypertension, 83; ischemic heart disease, 43; heart failure, 7; stroke or TIA, 9) and in 212 (18%) a history of airways disease was recorded (asthma, 193; chronic airflow limitation, 19). Seventy-two (6.0%) were prescribed b-blockers and/or ACE inhibitors (b-blockers only 15, ACE inhibitors only 51, both 6).…”

Diagnostics in Hymenoptera venom allergy: current concepts and developments with special focus on molecular allergy diagnostics

“…It has been argued that a diagnostic sting challenge reduces the socio-economic burden of HVA. Using a diagnostic sting challenge to confirm the clinical relevance of a sensitization, one study group argued that VIT could be withheld from 83% of YJV and 56% of HBV allergic patients, due to tolerance of the diagnostic sting challenge [69]. Another study from the same time showed the diagnostic sting challenge to be unreliable as 21% of patients tolerating an initial sting challenge developed anaphylaxis following a second sting challenge [70].…”

Prevention of anaphylaxis with ant venom immunotherapy

“…. ], 50% for bee stings and only 25% for yellow jacket stings [30,31]. The natural history of IFA sting allergy remains to be determined.…”