Investigational and clinical use of the sting challenge

The sting challenge has been an important tool in advancing our knowledge about allergy to stings from insects in the order Hymenoptera. While some European centers have advocated its use in the past as a routine diagnostic procedure to select patients requiring venom immunotherapy, this practice has been abandoned because of the poor reproducibility of the test. In this review, the possible use of the sting challenge in clinical practice is discussed in the light of current knowledge of the limitations of the test. Its use in recent studies is also discussed, with an emphasis on the implications of the test's variability.

Several studies have attempted to quantify the risk of recurrence of anaphylactic reactions to hymenoptera stings under various clinical circumstances on the basis of the outcome of a single sting challenge. Many of these studies were carried out with small patient numbers, and consequently must be interpreted with caution.

While the sting challenge with a living insect is still the best available test for ascertaining clinical reactivity to insect venoms, the reproducibility of this procedure is modest. The outcome of single sting challenges in individual patients should therefore be interpreted with caution, in both the research setting and clinical practice.