The Stinging Insect Hypersensitivity practice parameter (1) is an excellent resource for questions related to indications for testing and IT. The parameter clearly states that in a patient in whom testing is indicated, either positive skin testing OR serum specific IgE can be used for diagnosis and treatment. While skin testing remains preferred, serum specific IgE testing also has high sensitivity. That being said, if the history supports a severe reaction to Hymenoptera and serum IgE testing is negative, further evaluation is recommended. This would include measurement of tryptase to evaluate for underlying mast cell disorder. I would also consider repeating the serum IgE testing and performing skin testing once available to you.
1. Golden DB, Demain J, Freeman T, Graft D, Tankersley M, Tracy J, Blessing-Moore J, Bernstein D, Dinakar C, Greenhawt M, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Wallace D. Stinging insect hypersensitivity: A practice parameter update 2016. Ann Allergy Asthma Immunol. 2017;118(1):28-54. Epub 2016/12/23. doi: 10.1016/j.anai.2016.10.031. PubMed PMID: 28007086.
I hope this information is helpful.
Daniel J. Jackson, MD, FAAAAI