INSECT-STING CHALLENGE IN 324 SUBJECTS WITH A PREVIOUS ANAPHYLACTIC REACTION - CURRENT CRITERIA FOR INSECT-VENOM HYPERSENSITIVITY DO NOT PREDICT THE OCCURRENCE AND THE SEVERITY OF ANAPHYLAXIS

Three hundred twenty-four patients with a history of yellow jacket- (n = 272) or honeybee- (n = 52) sting anaphylaxis were prospectively sub jected to an in-hospital sting challenge. Plasma levels of specific Ig E and IgG(4), skin venom tests, severity of previous reaction, sex, ag e, atopic constitution, histamine skin test results, location and numb er of previous stings, time interval between previous anaphylactic rea ction and sting challenge, and time interval between sting challenge a nd onset of anaphylaxis were studied in relation to the clinical sever ity of a reaction after sting challenge. A recurrent anaphylactic reac tion after sting challenge was observed in 25% of yellow jacket- and i n 52% of honeybee-sensitive persons. The severity of this reaction cor related significantly with age and the time interval between sting cha llenge and onset of anaphylaxis only: older persons with faster reacti ons had more severe symptoms after sting challenge. None of the curren t criteria for insect-sting hypersensitivity (IgE, IgG(4), skin test) significantly related on an individual basis or in combinations to the reaction after sting challenge. We conclude chat the current criteria to assess insect-venom hypersensitivity do not relate to the occurren ce and severity of anaphylactic symptoms after an insect-sting challen ge.