In-hospital sting challenge during venom immunotherapy has a high negative predictive value for subsequent sting...

Hymenoptera venom allergy is the most frequent elicitor of anaphylaxis in adults. Biomarkers predicting success of venom immunotherapy (VIT) are lacking. Only a re-sting may help to detect insufficiently protected individuals. The aim of the study was to investigate the prognostic value of a tolerated sting challenge with regard to future field stings.

A retrospective study included 585 consecutive patients of the AllergieZentrum Munich, Germany, who had tolerated a sting challenge test during VIT. Patients who were still on VIT were examined with a questionnaire evaluating the outcome of later field stings during ongoing VIT.

439 of 585 patients (75%) could be evaluated. Of the 439 patients, 74/102 (75.2%) had tolerated a sting challenge with bee, 288/401 (74.1%) with yellow jacket, and 67/82 (81.7%) with both insects. In the follow-up time, 24.6% (108) had experienced at least 1 field sting. 104 of 108 patients (96.2%) had tolerated the sting without any reaction. Four patients (3.8%) reported systemic symptoms, 2 of whom experienced mild allergic immediate-type symptoms (1.9%).

In patients on ongoing VIT a tolerated in-hospital sting provocation has a high negative predictive value (98.2%) in relation to the outcome of later field stings. The majority of these patients will subsequently not develop systemic reactions.