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Winged hymenoptera: Discordance between In vitro and In vivo sensitization.

Veronica Alix1, Jareatha Abdul Raheem2, Lauren Gabreski3

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Summary
This summary is machine-generated.

Hymenoptera venom allergy diagnosis requires both skin and serologic testing due to frequent discordance. Skin testing may be preferred first in specific patient groups for accurate allergy diagnosis.

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Area of Science:

  • Allergy and Immunology
  • Diagnostic Testing
  • Hymenoptera Venom Allergy

Background:

  • Hymenoptera venom allergy diagnosis relies on sting reactions and venom-specific immunoglobulin E (IgE) via skin or serologic tests.
  • Previous studies report discordance between skin and serologic testing, with guidelines emphasizing complementary use.
  • Accurate diagnosis is crucial for initiating venom immunotherapy.

Purpose of the Study:

  • To assess the discordance between skin and serologic venom-specific IgE testing.
  • To identify factors influencing the concordance of these diagnostic methods.
  • To inform clinical practice regarding optimal allergy testing strategies.

Main Methods:

  • Retrospective review of 125 patients diagnosed with winged Hymenoptera venom allergy.
  • Inclusion criteria: allergist diagnosis, prescribed venom immunotherapy, and both skin and serologic testing results.
  • Data collected: demographics, reaction severity (Mueller grade), and venom testing outcomes.

Main Results:

  • 33 patients met inclusion criteria; ages 7-69, 55% female, 94% with Mueller grade ≥2 reactions.
  • Low concordance observed (Kappa coefficients <0.35) with overall discordance at 37%.
  • Skin testing yielded more positive results than serologic testing, particularly in males, adults stung after 18, tested after 30, or with >5 years post-sting.

Conclusions:

  • Skin and serologic testing for Hymenoptera venom allergy frequently show discordant results.
  • Both testing modalities are recommended to confirm or refute allergy diagnoses.
  • Skin testing may be the preferred initial approach for certain patient populations.