HYMENOPTERA VENOM SKIN TESTING: ADOPTING AN ACCELERATED TEST METHOD

Abstract

<h3>Introduction</h3> The standard method of hymenoptera venom intradermal skin testing (IDST) is performed at a starting concentration of 0.001 to 0.01 μg/ml and increased every 10-fold until positive or maximum concentration of 1 μg/ml. Accelerated methods such as a 1-step method utilizing only the 1 μg/ml have been reported as safe, however many institutions have not adopted this approach. Our objective is to determine and compare the outcomes and safety of standard and accelerated venom IDST. <h3>Methods</h3> This is a retrospective chart review of patients with suspected venom allergy who underwent IDST at three allergy clinics within a single health care system. Demographic data, test method (standard vs. accelerated), test results, and adverse reactions were reviewed. <h3>Results</h3> Data collection is ongoing. Two out of 119 patients (1.7%) who underwent standard venom IDST experienced adverse reactions while none of 24 patients who underwent accelerated venom IDST experienced adverse reaction. One patient, with a history of chronic urticaria, experienced urticaria. The other experienced anaphylaxis requiring epinephrine although had tested negative to all venom concentrations. Within the standard method, ≥80% of positive results occurred at concentrations of 0.1 or 1 μg/ml, and ≥60% of positive results occurred at 1 μg/ml for all species except wasp which was 45% and 40% at 0.1 and 1 μg/ml respectively. <h3>Conclusion</h3> The result of this study underscores the safety of venom allergy testing. As majority of positive results occurred at 0.1 or 1 μg/ml, adopting an accelerated approach would reduce time and cost associated with testing.