Hymenoptera venom skin testing: Adopting an accelerated test protocol

Abstract

Background: The standard method of Hymenoptera venom intradermal skin test is performed at a starting concentration of 0.001 to 0.01 μg/mL and increased by 10-fold concentrations until positive or a maximum concentration of 1 μg/mL. Accelerated methods that start at higher concentrations have been reported as safe; however, many institutions have not adopted this approach.

Objective: To compare the outcome and safety of standard and accelerated venom skin test protocols.

Methods: This was a retrospective chart review of patients with suspected venom allergy who underwent skin testing at 4 allergy clinics within a single health care system from 2012 to 2022. Demographic data, test protocol (standard vs accelerated), test results, and adverse reactions were reviewed.

Results: Of 134 patients who underwent standard venom skin test, 2 (1.5%) experienced an adverse reaction, whereas none of the 77 patients who underwent accelerated venom skin test experienced an adverse reaction. One patient, with a history of chronic urticaria, experienced urticaria. The other experienced anaphylaxis requiring an epinephrine although had tested negative to all venom concentrations. Within the standard testing protocol, more than 75% of the positive results occurred at concentrations of 0.1 or 1 μg/mL. Within the accelerated testing protocol, more than 60% of the positive results occurred at 1 μg/mL.

Conclusion: The study underscores the overall safety of venom intradermal skin test. Most of the positive results occurred at 0.1 or 1 μg/mL. Adopting an accelerated approach would reduce time and cost associated with testing.