Should We Consider Venom Immunotherapy When Levels of Specific IgE to Insect Venom Is Between 0.1 and 0.34?

Venom immunotherapy (VIT) improves quality of life and is potentially lifesaving in patients with anaphylactic reactions to stinging insect venom and evidence of immunoglobulin E (IgE)–mediated sensitization. Sensitization is defined as either a positive skin test to insect venom or a serum venom–specific IgE level that is equal to or above 0.35 kU/L. With the advent of advanced diagnostics, levels of sensitization as low as 0.1 kU/L can be appreciated; however, the approach to patients with a low level of sensitization (defined as venom-specific IgE levels between 0.1 and 0.34 kU/L) remains debatable. In addition, when considering VIT for selected patients with large local reactions or cutaneous systemic reactions, encountering low levels of sensitization can complicate the clinical decision. In this pro/con debate, we discuss whether patients who had an anaphylactic reaction, cutaneous systemic reaction, or large local reaction to insect venom should receive VIT when diagnostic evaluation only reveals sensitization between 0.1 and 0.34 kU/L and negative skin testing. The pro position is presented by T. Al-Shaikhly, and the con position is discussed by T. J. Craig. Dr. Golden served as moderator and fact-checker. This review is not intended to address the medical legal aspects, rather to direct research and clinical studies.