Venom anaphylaxis
Question:
9/14/2020
A 15 year-old female experienced anaphylaxis from wasp sting. Testing was positive only for this venom and she completed a five year treatment one year ago. Surprisingly she had low grade positive IgE RAST results for all venoms lest year prompting skin testing now. These were positive for all venoms at 1mcg/ml. What do you think the clinical implication of these results means?
Answer:
If the only venom associated anaphylaxis the patient has experienced was from a wasp, and she has not had any other stings, then low grade positive IgE RAST results for all venoms after five years of venom immunotherapy probably represent clinically insignificant cross-reactivity between the venoms. If she has not had anaphylaxis from another field sting since starting her wasp venom immunotherapy, then repeat testing provides no clinically useful information. If her baseline tryptase is normal, then further venom immunotherapy appears not to be indicated at this time.
https://www.jacionline.org/article/S0091-6749(96)70302-0/fulltext
DOI: 10.1080/1744666X.2018.1413350
I hope this is helpful.
Eric Macy, MD, MS, FAAAAI