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OCTOBER 2004 QUIZ OF THE MONTH . . . You are evaluating a 35 year old telephone lineman with a past history of an episode of a large local reaction, acute dyspnea and faintness shortly after a sting by a "bee" 6 months earlier (patient unsure about the type of stinging insect). He exhibits negative responses to skin tests with the hymenoptera skin test panel using up of 1.0 mcg/ml concentration. Please respond, which of the statements about this patient are true or false? 1. The patient is not allergic to hymenoptera venom. The previous reaction was likely a vaso-vagal response to the fright of being stung by a bee. The patient should be reassured with no further action needed. 2. The negative hymenoptera skin tests are likely a reflection of transient hypo- responsiveness after the sting reaction. 3. The skin tests are negative because the sting was actually from a cicada wasp whose venom is not included in preparing the hymenoptera skin test panel. 4. One should obtain in vitro testing for anti-venom IgE Ab by a RAST-type assay. 5. The patient should be advised to carry an Epi-Pen with him whenever outdoors and instructed in its use.
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