I saw a 12 year-old girl who had been stung by a "yellow-jacket" (her words). About 45 minutes later, she began to "itch all over," describes having "welps" on her face. She also reported that her tongue felt "thick." I do not know where she was stung on her body. I assumed that she was NOT stung anywhere on her face. I took the approach that tongue feeling thick was a similar reaction to the welps and itching, and thus grouped all of these symptoms into the "cutaneous category." The practice parameters state that, for patients 16 and younger, who have experienced "only cutaneous systemic reactions," immunotherapy is NOT warranted. Therefore, I did NOT perform a full allergy evaluation. However, if one were to classify the reported sensation of tongue thickening into a category other than cutaneous, then immunotherapy would be warranted (assuming sensitization is shown), according to the parameters. In her case, I did perform skin testing, which was negative. Am I not following guidelines by not ordering specific IgE testing, and commencing with immunotherapy, if positive?