The Sting Challenge Test: An EAACI Position Paper on Hymenoptera Venom Allergy

A Sting Challenge Test (SCT) is the only reliable method to verify the effectiveness of venom immunotherapy (VIT) in patients allergic to Hymenoptera venom, a leading cause of anaphylaxis in adults. This European Academy of Allergy and Clinical Immunology (EAACI) position paper provides an in-depth analysis of the SCT's key applications, risks, and outcomes in clinical practice, focusing on its role in monitoring VIT efficacy, improving patient quality of life, and ensuring appropriate therapeutic interventions. The SCT is primarily used to assess VIT protection, adjust VIT dosage, and confirm patient safety but is not recommended for routine diagnosis due to the risk of provoking systemic allergic reactions. This position paper also offers practical considerations for performing the SCT, including insect handling, patient preparation, and risk management. While SCT is a valuable tool in personalized allergy treatment, it requires careful handling of live insects and patient preparation to ensure safety. This position paper reviews the literature and presents the expert experience of the Insect Venom Hypersensitivity Working Group of the European Academy of Allergy and Clinical Immunology.