Accelerated Hymenoptera testing in pediatric patients
Elizabeth S Brunner1, Jeffrey M Chambliss1, Timothy G Chow1
1Division of Allergy and Immunology, Department of Pediatrics and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex.
Insights
Accelerated skin testing for Hymenoptera venom allergy is safe for children. This study found no adverse events in pediatric patients undergoing rapid allergy testing for Hymenoptera stings.
Area of Science:
- Allergy and Immunology
- Pediatric Medicine
- Diagnostic Testing
Background:
- Hymenoptera sensitization requires skin testing for systemic reactions.
- Accelerated skin testing protocols exist for adults but lack pediatric data.
Purpose of the Study:
- To evaluate the safety of an accelerated Hymenoptera skin testing protocol in children.
- To assess Hymenoptera venom hypersensitivity in pediatric patients.
Main Methods:
- Retrospective chart review of pediatric patients (2017-2024).
- Inclusion criteria: history of systemic reaction to Hymenoptera sting, completed allergy testing.
- Data collected: demographics, reaction/testing age, atopy, severity, testing details.
Main Results:
- 61 pediatric patients included; 80% had moderate to severe reactions (Mueller grade 2-4).
- 36 patients received accelerated intradermal testing (flying Hymenoptera or fire ant).
- No adverse events or systemic reactions occurred during accelerated testing.
Conclusions:
- Accelerated Hymenoptera skin testing appears safe in the pediatric population.
- Further multicenter studies are recommended to confirm safety and efficacy.
Background:
Skin testing is an important component of evaluating Hymenoptera sensitization in patients presenting with a suspected Hymenoptera systemic reaction. Accelerated skin testing protocols have been reported in adults, but they have not been evaluated in children.
Objective:
Our aim was to assess the safety of an accelerated Hymenoptera testing protocol in the evaluation of Hymenoptera venom hypersensitivity systemic reactions in pediatric patients.
Methods:
A retrospective chart review of pediatric patients evaluated for Hymenoptera venom allergy at an academic allergy clinic from January 2017 through December 2024 was conducted. The children included in the study had a history consistent with a systemic reaction, as determined by a board-certified allergist to a sting and completed Hymenoptera allergy testing. The variables collected included demographic factors, age at initial reaction, age at skin testing, comorbid atopy, Mueller severity score reaction grade, reagents and concentrations used for skin testing, and skin testing results.
Results:
A total of 61 patients were included. Of those patients, 80% presented with systemic reactions having a Mueller grade of 2 to 4. The median age at initial sting reaction was 5 years (interquartile range 2.75-8 years), and the median age at skin testing was 6 years (interquartile range 3-8 years). In all, 36 patients underwent accelerated intradermal testing (12 for flying Hymenoptera allergy, 24 for fire ant allergy); there were no adverse events or systemic reactions to testing.
Conclusion:
Our findings provide initial evidence suggesting that an accelerated Hymenoptera skin testing protocol is safe in the pediatric population and encouraging subsequent larger, multicenter studies evaluating the safety of this diagnostic approach.
