BEE-VENOM ALLERGY IN CHILDREN - LONG-TERM PREDICTIVE VALUE OF STANDARDIZED CHALLENGE TESTS

Specific immunotherapy is able to protect insect allergic patients aga inst life-threatening sting reactions. Initiation of immunotherapy can be decided on the basis of challenge tests. However, at least for chi ldhood no data were available about the longterm predictive value of s ting challenge tests. Between 1988 and 1991, in 92 bee venom allergic children two sequential bee sting challenges one to three weeks apart from each other were performed using living bees or Reless bee-venom. The predictive ability of the initial test results regarding the natur al follow-up history was now investigated. In August 1996 all 92 famil ies could be re-contacted. For 48 children (52%) at least one natural sting exposure was reported, of whom twelve patients were treated with specific immunotherapy. One of them experienced a severe and one a mi ld systemic reaction. Among the 36 re-stung patients without immunothe rapy, two children experienced mild systemic reactions whereas in 34 c hildren only a local reaction was reported. Thus, the negative predict ive value of sequential bee sting challenge tests without systemic rea ctions remains at a level of 94.4% (95%-confidence interval: 81.3-99.0 %) even over a period of more than five years.