Q:

4/27/2014
I sometimes see pts with prior systemic insect sting reactions in the office for whom the reaction occurred some years ago. Some of these patients did have prior testing performed (either at our office or another allergist) and then either opted not to pursue VIT or started on VIT but did not continue adequately (i.e. less than 5 yrs). These pts are candidates for venom immunotherapy based on history. Should they be retested prior to pursuing VIT to decide on which venoms to treat, or should VIT be resumed based on prior results? What if retesting shows fewer or no current positives?

A:

Thank you for your inquiry.

I am not aware of any consensus opinion on how to approach such patients, but I can share with you my own strategy. I do reskin test these patients. In my opinion, they should be treated as if they had never been evaluated, and the same procedures for skin testing and, when indicated, in vitro testing should be applied as outlined in the most recent Practice Parameter by Drs. Golden, et al. (1). Therefore you would treat these patients only to whatever skin tests were positive, and if none were positive, you should use the approach outlined in the reference noted above (obtaining a serum specific IgE) and then consider repeating the sequence of testing again in three to six months if both skin and in vitro tests are negative. If both tests remain negative, then the patient should not be treated with immunotherapy.

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

Reference:
1. Golden DBK, et al. Stinging insect hypersensitivity: a practice parameter update 2011. J Allergy Clin Immunol 2011; 127(4):852-854.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology