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The Sting Challenge Test Shows High Negative Predictive Value in Patients Receiving Venom Immunotherapy
T Alfaya Arias1, A Vega Castro2,3, D Garnica-Velandia4,5
1Allergy Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
Background And Objective:
The sting challenge test (SCT) is regarded as the most reliable method for assessing the effectiveness of venom immunotherapy (VIT). However, its predictive value in patients undergoing VIT is unclear. Objective: This study aims to evaluate the predictive value of the SCT.
Methods:
A multicenter retrospective observational study was conducted on patients receiving VIT who underwent SCT. The study gathered data on patient demographics, diagnosis, immunotherapy details, outcomes of the SCT, and subsequent field stings.
Results:
A total of 261 patients were included, and 372 SCTs were recorded. Most patients (75.1%) were men. Mastocytosis was confirmed in 7.7%. The final diagnosis was allergy to Apis mellifera (48.7%), Polistes dominula (36.8%), Vespula species (2.7%), and P dominula plus Vespula species (10.7%). SCTs were performed with Apis in 61.6% overall, Polistes in 34.1%, and Vespula in 4.3%. Most of the SCT results were negative (95.7%). A total of 306 field stings were recorded for 146 patients (56.2%); of these, 95.1% were negative. Among these 146 affected patients, 137 had a negative SCT result, and 130 of these also had a subsequent negative field sting, resulting in a negative predictive value (NPV) for the SCT of 94.9%. Of the patients who experienced a field sting, 9 had a positive SCT, and only 3 had a positive field sting, resulting in a positive predictive value of 33.3%.
Conclusions:
SCT is safe, and the high NPV emphasizes the usefulness of this test in assessing the effectiveness of VIT.
