Sped-Up IDT an Option After Flying-Bug Stings

LOUISVILLE, Ky. — An accelerated form of intradermal skin testing (IDT) was found feasible and safe in patients with suspected allergies to hymenoptera venom, such as those from bee and wasp stings, researchers stated.

In a retrospective study comparing adverse events (AEs) in patients who underwent standard and accelerated flying hymenoptera venom IDT, none of the 77 patients who got the latter had AEs versus 1.5% of those who received standard IDT, reported Qing Wang, MD, of the Walter Reed National Military Medical Center in Bethesda, Maryland.

Wang and colleagues noted in a electronic poster presentation at the American College of Allergy, Asthma & Immunology annual meeting that the standard method of flying hymenoptera venom IDT is done at a starting concentration of 0.001 μg/ml or 0.01 μg/ml, and then increased 10-fold in steps until a positive test is observed or if the diagnostic testing dose reaches 1 μg/ml. For accelerated IDT, the first dose is ≥1 μg/ml.

“The results of this study underscores the safety of venom skin testing to include the accelerated method of intradermal skin testing performed at these [military] medical centers,” Wang told MedPage Today. “The accelerated test is much faster because you are skipping all these lower-dose steps.”

She explained that with standard treatment, the patient gets the first IDT, and then there is usually a 15-minute wait before subsequent doses, which means a full test can take a couple of hours Wang noted that saving time on testing was particularly important with “pediatric cases because children might not like all of those needles.” She related that there were two children in the study who underwent standard IDT, but then did not want any more testing done after the first dose.

Matthew Balanda, RN, FNP-BC, of the Center for Allergy, Asthma and Immunology in Waterbury, Connecticut, told MedPage Today that “at our center, we now start with 1 μg/ml. This is a reasonable procedure, and it is pragmatic as well. It saves time for both us and for the patients.”

Wang’s group reviewed health records (20012-2022) from four Department of Defense Military Health System hospitals with allergy clinics. They identified 134 individuals tested with standard IDT (mean age 39; 57.14% female) and 77 (mean age 34; 64.94% male) with accelerated IDT. The time from last reaction was ≥5 years in more than half of both groups. They experienced stings from various flying bugs including honeybees, hornets, and wasps.

Among the standard IDT patients with AEs, one developed urticaria after 0.01 μg/ml, although the patient repeated the test on another day. The second patient developed anaphylaxis 15 minute after completing a pan-negative skin test. This patient underwent testing on another day and had the same reaction.