Diagnostic methods for insect sting allergy

Research output: Contribution to journalReview articlepeer-review

45 Scopus citations


Purpose of review: This review overviews advances from mid-2002 to the present in the validation and performance methods used in the diagnosis of Hymenoptera venom-induced immediate-type hypersensitivity. Recent findings: The general diagnostic algorithm for insect sting allergy is initially discussed with an examination of the AAAAI's 2003 revised practice parameter guidelines. Changes as a result of a greater recognition of skin test negative systemic reactors include repeat analysis of all testing and acceptance of serology as a complementary diagnostic test to the skin test. Original data examining concordance of venom-specific IgE results produced by the second-generation Pharmacia CAP System with the Johns Hopkins University radioallergosorbent test are presented. Diagnostic performance of honeybee venom-specific IgE assays used in clinical laboratories in North America is discussed using data from the Diagnostic Allergy Proficiency Survey conducted by the College of American Pathologists. Validity of venom-specific IgE antibody in postmortem blood specimens is demonstrated. The utility of alternative in-vivo (provocation) and in-vitro (basophil-based) diagnostic testing methods is critiqued. Summary: This overview supports the following conclusions. Improved practice parameter guidelines include serology and skin test as complementary in supporting a positive clinical history during the diagnostic process. Data are provided which support the analytical performance of commercially available venom-specific IgE antibody serology-based assays. Intentional sting challenge in-vivo provocation, in-vitro basophil flow cytometry (CD63, CD203c) based assays, and in-vitro basophil histamine and sulfidoleukotriene release assays have their utility in the study of difficult diagnostic cases, but their use will remain as supplementary, secondary diagnostic tests.

Original languageEnglish (US)
Pages (from-to)297-306
Number of pages10
JournalCurrent opinion in allergy and clinical immunology
Issue number4
StatePublished - Aug 2004


  • Basophil release
  • Histamine
  • Hymenoptera venom
  • In-vivo and in-vitro diagnosis
  • Provocation test
  • Recombinant allergens
  • Skin test
  • Sting challenge
  • Sulfidoleukotriene
  • Venom-specific immunoglobulin E antibody

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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