Q:

3/26/2013
A 61 year old male pt. has a history of questionable anaphylaxis to bee sting. He was 1st stung multiple times on one occasion in 2010. He experienced only swelling at site of sting. The swelling lasted for several weeks. He was stung again in 2012 on the neck and immediately developed swelling in the arm that he was stung in 2010. He was rx an EpiPen in 2010, he immediately used it in 2012 and went to the ER. He did feel slight difficulty breathing however he was unsure if r/t sting or anxiety.

He presented to our office one month ago for venom testing. He had positive skin test to wasp, white hornet, yellow hornet and yellow jacket at .1mcg/ml and positive skin test to honeybee at 1 mcg/ml. Should he receive venom immunotherapy based on the above findings? Thank you.

A:

Thank you for your inquiry.

Unfortunately I cannot give you a definite answer to your question. In my opinion, if you asked multiple allergists-immunologists this question, you would get different answers. Certainly, there is little in this patient’s history to suggest a bona fide anaphylactic reaction, but now that he has been tested and has shown multiple positive reactions, we are left with a clinical decision which is colored not only by the medical facts but also by medicolegal issues. All in all, the answer is going to be solely dependent upon the clinical judgment of the physician in charge of his therapy.

I probably would initiate venom immunotherapy in this case, but I would certainly not argue with the opposite decision.

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