In a patient with anaphylaxis and loss of consciousness from stinging insect, suspected to be yellow jacket, the sIgE was significantly positive to all vespids, but honeybee and paper wasp were only 0.44, would you evaluate further with skin testing to wasp and decide on including wasp in treatment based on skin testing being positive or include it with just the low IgE level?

The wasp IgE may be cross-reactive with YJ, and if the YJ is more than 5 times higher than Polistes IgE then this is almost certainly the case, which would suggest that Polistes VIT is not necessary. However, there is no available test to prove the cross-reactivity, so given the severity of the reac...

Although the honeybee and paper wasp sIgE levels were detectable, the low levels of sIgE make reactions to future stings less likely. However, because you are starting VIT for other venoms, I would consider including these venoms in the VIT cocktail.

Aside from the specific question raised, I also w...