A 46 year-old male presented with the question of whether he should undergo another course of venom immunotherapy. At age 13, he had been stung and had a systemic reaction with throat tightness, hives, and swelling. He received venom immunotherapy for 11 years following that episode. While undergoing venom IT he was stung twice and did not have adverse reactions.
He has not been stung since then, and has always carried injectable epinephrine, but now he is concerned because he will be starting to work as an umpire and will be spending more time outdoors.
Immunocap testing was as follows: Honeybee 1.21 kU/L, white-faced hornet 0.99, yellow jacket 0.71, paper wasp 0.67, and yellow hornet 1.07. Skin testing has not been performed.
Total IgE is 487 and he also has dust mite, pollen, pet, and mold allergies that he does not wish to treat.
Serum tryptase is 4.
Would you recommend proceeding with another course of immunotherapy based on the above history and testing, given that he still has positive serum IgE testing?