HYMENOPTERA STING CHALLENGE OF 348 PATIENTS - RELATION TO SUBSEQUENT FIELD STINGS

Background: Patients with a history of a serious anaphylactic reaction after a Hymenoptera sting are usually given venom immunotherapy. Beca use the natural history of Hymenoptera sting anaphylaxis is often of a declining severity, there is a chance of overtreatment. Objective: id entification of patients at risk for a future anaphylactic reaction ma y reduce the number of patients who need venom immunotherapy. Methods: We investigated the relation between the grade of hypersensitivity to an in-hospital sting challenge and the reaction to a subsequent accid ental field sting. From 1982 through 1992, 348 patients with mild or n o symptoms after a sting challenge were not given venom immunotherapy. All patients were asked by letter whether they had experienced a subs equent field sting. In case of a sting, the severity of the reaction w as further evaluated. Results: Information could be obtained from 327 patients: 129 had been re-stung, and 110 of them had only had a local reaction. Thirteen patients had experienced mild systemic symptoms, an d six patients had experienced serious manifestations. In two of the l atter group hypotension was observed. Conclusion: In 95% of patients w ith a previous anaphylactic reaction, the result of the in-hospital st ing challenge provided a good prediction of tolerance to a subsequent Hymenoptera field sting.