Q:

4/22/2013
Thank you for your help. I am presented with an 18 year old who at the age of 2 years had an insect sting (honey bee or hornet) immediately resulting in generalized rash (urticaria from description). To be cautious, Mom had the child prescribed an Epi Pen. Now the young man is being rejected from the Service as the RAST and Immunocap testings are coming Class I for Honey Bee and White faced Hornet. I feel the young man is at no significant risk from any subsequent stings as compared to others. I would not have done the blood work as no VIT would be indicated. Should he undergo a sting challenge to clarify his status? Should he under go VIT. The young man is going to lose his scholarship due to this. Thank you again for any suggestions.

A:

Thank you for your inquiry.

I am of course in agreement with your impression and see no reason for this young man not to be able to serve in the military. Unfortunately, however, there is no standard foolproof way to convince the military of this conclusion. I can only share with you what we normally do in such a circumstance.

I write a letter clearly stating my opinion and supplement it with information taken from the literature, and state that I would be happy to perform a medical review or speak to the physician who does entry physical examinations for the military service. On most occasions, I have found this to be effective, and the military is willing to accept the candidate. I have never personally done a sting challenge nor have I had to institute venom immunotherapy under these circumstances.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology