#EntomologyConsult: patient had a #yellowjacket sting resulting in anaphylaxis. However a subsequent sting resulted in only a local reaction. Are they really allergic to Vespula? Do you need to do a sting challenge in clinic before desensitizing?
In those with venom-induced anaphylaxis reactions only develop in 25-70% of stings. Even in controlled sting challenges where species are confirmed 20% with no reaction from intentional stings react with subsequent stings. Sting challenges aren’t reliable. https://www.jacionline.org/article/0091-6749(94)90351-4/pdf
Lack of reproducibility of a single negative sting challenge response in the assessment of anaphy...

To investigate the reproducibility of a single negative response to sting challenge with a living insect, we rechallenged a group of 61 patients who showed no clinical response to a first sting...

https://www.jacionline.org/article/0091-6749(94)90351-4/pdf
Beyond the variability in the immune response, I suspect that some stings are from different genera that look like Vespula, such as Polistes, Vespa, and Dolichovespula that don’t always cross-react with Vespula venom
Beyond the variability in the immune response, I suspect that some stings are from different genera that look like Vespula, such as Polistes, Vespa, and Dolichovespula that don’t always cross-react with Vespula venom
Beyond the variability in the immune response, I suspect that some stings are from different genera that look like Vespula, such as Polistes, Vespa, and Dolichovespula that don’t always cross-react with Vespula venom
Beyond the variability in the immune response, I suspect that some stings are from different genera that look like Vespula, such as Polistes, Vespa, and Dolichovespula that don’t always cross-react with Vespula venom
When we get the specimens that actually caused the stings or nestmates from a disturbed nest (collected by those without venom allergy!) it is very helpful. Photographs are also increasingly useful in ensuring we have the right species
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