Simplification of intradermal skin testing in Hymenoptera venom allergic children

Background The direct comparison between children and adults with Hymenoptera venom anaphylaxis (HVA) has never been extensively reported. Severe HVA with IgE-documented mechanism is the recommendation for venom immunotherapy, regardless of age. Objective To determine the differences in the basic diagnostic profile between children and adults with severe HVA and its practical implications. Methods We reviewed the medical records of 91 children and 121 adults. Results Bee venom allergy was exposure dependent, regardless of age ( P P = .01), whereas cardiovascular comorbidities were present almost exclusively in adults ( P = .001). In the bee venom allergic group, specific IgE levels were significantly higher in children (29.5 kU A /L; interquartile range, 11.30-66.30 kU A /L) compared with adults (5.10 kU A /L; interquartile range, 2.03–8.30 kU A /L) ( P P P = .002), as well as in bee ( P = .002) and wasp venom allergic groups ( P = .049). Conclusion The basic diagnostic profile in severe HVA reactors is age dependent. Lower skin test reactivity to culprit venom in children may have practical application in starting the intradermal test procedure with higher venom concentrations.