I have a 61 year-old patient with documented hypotension following hymenoptera sting in 1989. He has received mixed vespid injections since 10/28/1989. Tryptase level 5.9. Negative skin testing on 4/13/2018. Should he continue injection rx or D/C at this time?


The 2016 Stinging Insect Hypersensitivity Practice Parameter would suggest a shared decision after discussion with the patient weighing the criteria to discontinue (well over 3-5 year duration of therapy, normal tryptase, negative skin testing, presumptively a conversion) against those to continue indefinitely (hypotension as the initial reaction) with consideration of his lifestyle and occupational risk for exposure.

Patricia McNally, MD, FAAAAI


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