Don't Perform Hymenoptera Skin Tests on Patients Without Previous Systemic Reactions

Almost all adults have been stung by Hymenoptera (honey bees, wasps, hornets, or yellow jackets) at some point. Fewer than 7% of people who are stung experience systemic sting reactions (SSRs; generalized hives, angioedema, or anaphylactic symptoms), and about a quarter have large local reactions (LLRs). However, specific IgE antibodies to Hymenoptera venoms can be detected in 40% of the general population, so most sensitized individuals are not allergic to Hymenoptera venoms. Venom immunotherapy is indicated only for systemic reactions and is not recommended for LLRs or asymptomatic sensitization.

In an Austrian study, 94 people who had positive skin tests and specific IgE antibodies to Hymenoptera venom but had never experienced SSRs under…