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