SUBSEQUENT INSECT STINGS IN CHILDREN WITH HYPERSENSITIVITY TO HYMENOPTERA

To investigate the risk of life-threatening reactions to future stings , we sequentially challenged 113 children (aged 2 to 17 years) allergi c to insect stings with a sting by the relevant insect, The time inter val between the challenges varied from 2 to 6 weeks. The history of th e index stings was a large local reaction (LR) in 16% and a systemic r eaction (SR) in 84% of the test subjects, On the first challenge, 76% had a normal LR, 11% a large LR, and 13% an SR, On the second challeng e, 78% of the children had a normal LR, 5% a large LR, and 17% an SR, Thirty-nine of the untreated children were exposed to a field sting du ring the subsequent 3-year follow-up period, In comparison with other diagnostic evaluations such as skin-prick tests, determinations of spe cific IgE and lgG antibodies, and single-sting exposure, the dual stin g challenge scheme appears to be the best predictor of reactions to su bsequent stings, It also appears to be helpful in selecting patients w ith an uncertain sensitization status for venom immunotherapy.