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Evaluation of a modified skin prick test for diagnosis of Hymenoptera venom allergy

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Abstract

Purpose

Skin tests are an integral part in the diagnosis of allergy to Hymenoptera venom (HV). While usually these include skin prick tests (SPT) and intradermal tests (IDT) with venom extracts at a maximum concentration of 100 μg/ml and 1 μg/ml, respectively, in addition, a SPT with 300 μg/ml (SPT300) may be performed. The purpose of this study was to evaluate the diagnostic value of SPT300.

Methods

In all, 75 patients with history of anaphylaxis to HV were evaluated by SPT and IDT, including SPT300, as well as measuring HV-specific IgE antibodies. In a subgroup of monosensitized patients with IgE antibodies to either only wasp (WV) or bee venom (BV) the specificity and sensitivity of SPT300 was assessed.

Results

While 64 % and 68 % patients showed positive test results in SPT with 100 μg/ml (SPT100) and IDT with 1 μg/ml (IDT1) HV, respectively, 82.7 % reacted to SPT300, considering a mean wheal diameter (MWD) of at least 3 mm a positive skin reaction. Choosing either a MWD of 4 or 5 mm as threshold, merely 69.3 % and 32 % had a positive test result. Evaluation of individuals monosensitized to only WV (n = 27) or BV (n = 10) by IgE analysis revealed an almost equally satisfactory sensitivity of more than 80 % for SPT300, but also for SPT100 and IDT1 with both allergens. Of note, while the specificity of SPT300 for WV exceeded 90 %, it was markedly lower for SPT300 with BV (51.9 %). Other factors like atopy, grade of anaphylaxis, and the time lag between index sting and skin testing had no influence on the test results.

Conclusions

SPT300 shows a high but not substantially superior sensitivity utilizing both WV and BV extract for diagnosis of HV allergy compared to SPT100 and IDT1. However, since SPT300 with BV extract demonstrated a very low specificity, our results indicate that SPT300 has limited added value in the diagnosis of HV allergy.

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Abbreviations

BV:

Bee venom

HV:

Hymenoptera venom

IDT:

Intradermal test

MWD:

Mean wheal diameter

SPT:

Skin prick test

WV:

Wasp venom

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Authors and Affiliations

  1. Clinical and Experimental Allergology, Department of Dermatology and Allergology, Philipps University Marburg, Marburg, Germany

    Christian Möbs, Désirée Wiedemann &  Wolfgang Pfützner

  2. Comprehensive Allergy Center Hessen, Department of Dermatology and Allergology, University Medical Center Gießen and Marburg, Philipps University Marburg, Baldingerstraße, 35043, Marburg, Germany

    Wolfgang Pfützner

Authors
  1. Christian Möbs
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  2. Désirée Wiedemann
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  3. Wolfgang Pfützner
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Corresponding author

Correspondence to Wolfgang Pfützner.

Additional information

Electronic supplementary material

The online version of this article (www.springermedizin.de/allergo-journal) contains supplementary material, which is available to authorized users:

_ Fig. S1: Sensitivity and specificity of skin test responses using a cut-off value for specific IgE of 0.1 kUA/l.

_ Fig. S2: Consecutive skin testing of monosensitized patients using a cut-off value for specific IgE of 0.1 kUA/l.

_ Fig. S3: Sensitivity and specificity of skin test responses in patients with Hymenoptera venom allergy stratified according to low and high levels of total IgE

Funding

The study was supported by a grant from ALK-Abelló, Hamburg, Germany.

Conflict of interest

W. Pfützner has consultant arrangements with ALK-Abelló, Novartis and Thermo Fisher. C. Möbs and D. Wiedemann declare that they have no competing interests.

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Möbs C, Wiedemann D, Pfützner W. Evaluation of a modified skin prick test for diagnosis of Hymenoptera venom allergy. Allergo J Int 2019;28:43–9 https://doi.org/10.1007/s40629-018-0073-z

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Möbs, C., Wiedemann, D. & Pfützner, W. Evaluation of a modified skin prick test for diagnosis of Hymenoptera venom allergy. Allergo J 28, 20–27 (2019). https://doi.org/10.1007/s15007-019-1807-z

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  • DOI: https://doi.org/10.1007/s15007-019-1807-z

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