Bee-venom allergy in children: Longterm predictive value of standardized challenge tests.

Specific immunotherapy is able to protect insect allergic patients against life-threatening sting reactions. Initiation of immunotherapy can be decided on the basis of challenge tests. However, at least for childhood no data were available about the longterm predictive value of sting challenge tests. Between 1988 and 1991, in 92 bee venom allergic children two sequential bee sting challenges one to three weeks apart from each other were performed using living bees or Reless bee-venom. The predictive ability of the initial test results regarding the natural follow-up history was now investigated. In August 1996 all 92 families could be re-contacted. For 48 children (52%) at least one natural sting exposure was reported, of whom twelve patients were treated with specific immunotherapy. One of them experienced a severe and one a mild systemic reaction. Among the 36 re-stung patients without immunotherapy, two children experienced mild systemic reactions whereas in 34 children only a local reaction was reported. Thus, the negative predictive value of sequential bee sting challenge tests without systemic reactions remains at a level of 94.4% (95%-confidence interval: 81.3-99.0%) even over a period of more than five years.