Hymenoptera venom skin testing: Adopting an accelerated test protocol

The standard method of Hymenoptera venom intradermal skin test is performed at a starting concentration of 0.001 to 0.01 μg/mL and increased by 10-fold concentrations until positive or a maximum concentration of 1 μg/mL. Accelerated methods that start at higher concentrations have been reported as safe; however, many institutions have not adopted this approach.

To compare the outcome and safety of standard and accelerated venom skin test protocols.

This was a retrospective chart review of patients with suspected venom allergy who underwent skin testing at 4 allergy clinics within a single health care system from 2012 to 2022. Demographic data, test protocol (standard vs accelerated), test results, and adverse reactions were reviewed.

Of 134 patients who underwent standard venom skin test, 2 (1.5%) experienced an adverse reaction, whereas none of the 77 patients who underwent accelerated venom skin test experienced an adverse reaction. One patient, with a history of chronic urticaria, experienced urticaria. The other experienced anaphylaxis requiring an epinephrine although had tested negative to all venom concentrations. Within the standard testing protocol, more than 75% of the positive results occurred at concentrations of 0.1 or 1 μg/mL. Within the accelerated testing protocol, more than 60% of the positive results occurred at 1 μg/mL.

The study underscores the overall safety of venom intradermal skin test. Most of the positive results occurred at 0.1 or 1 μg/mL. Adopting an accelerated approach would reduce time and cost associated with testing.