A 'Difficult' Insect Allergy Patient

Reliable History of a Sting, but All Testing Negative

James M. Tracy; Jonathan A. Olsen; John Carlson


Curr Opin Allergy Clin Immunol. 2015;15(4):358-363. 

In This Article


The patient who has a history of anaphylaxis following an insect sting, yet all testing fails to identify venom-specific IgE, creates both a diagnostic challenge and therapeutic dilemma. This failure does not provide the opportunity to offer venom immunotherapy, which carries a protective level approaching 98%. There are many potential sources for this diagnostic challenge. Current diagnostic testing for venom allergy is sensitive and specific, but is imperfect and many important diagnostic opportunities are missed. Unfortunately, newer options are not widely available. Occult mast cell disease and potentially other immunologic, non-IgE-mediated causes may account for a segment of these affected patients. However, in the end, it may be as simple as not testing for the correct insect.