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The Lights and the Shadows of Controlled Sting Challenge With Hymenoptera

Ruiz-León B1,2,3, Martínez San Ireneo M4, de la Roca F5,6, Arenas L7, Alfaya Arias T8, Cordobés C9,
Marqués L10, Vega A3,11, Moreno-Aguilar C1,2,3, on behalf of the Hymenoptera Allergy Committee
of the Sociedad Española de Alergología e Inmunología Clínica (SEAIC)

1Immunology and Allergy Department, Hospital Universitario Reina Sofía, Córdoba, Spain
2Instituto de Salud Carlos III, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
3ARADyAL Spanish Thematic Network and Co-operative Research Centre
4Allergy Department, Hospital Virgen del Valle, Toledo, Spain
5ClinicAL, Barcelona, Spain
6Unidad Alergo Rino, Centro Médico Teknon, Barcelona, Spain
7Allergy Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
8Allergy Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
9Allergy Department, Hospital de Mérida, Badajoz, Spain
10Allergy Department, Hospitales Universitarios Santa María y Arnau de Vilanova, IRBLleida, Lleida, Spain
11Allergy Department, Hospital Universitario de Guadalajara, Guadalajara, Spain

J Investig Allergol Clin Immunol 2022; Vol 32(5) : 357-366
doi: 10.18176/jiaci.0838

Hymenoptera venom immunotherapy (VIT) is effective for protecting individuals with systemic allergic reactions caused by Hymenoptera stings. The need for a tool that shows the degree of protection afforded by VIT and the lack of useful biomarkers have made the sting challenge test (SCT) the gold standard for this disorder, although its use has both lights and shadows. SCT with Hymenoptera involves causing a real sting in a patient diagnosed with allergy to the venom of the stinging insect and who is undergoing treatment with specific immunotherapy. In Spain, SCT is included in the list of services offered by some hospitals and forms part of their daily clinical practice. This review aims to analyze the strengths and weaknesses of this test and to describe the standardized procedure and necessary resources, based on the experience of a group of Spanish experts and a review of the literature.

Key words: Sting challenge test, Hymenoptera venom allergy, Venom immunotherapy