Detection of IgE antibodies specific to honeybee or Vespula venoms is an important criterium firstly for the diagnosis of sensitization and secondly for the indication for a specific immunotherapy. Some authors recommend to postpone blood analysis after an insect sting for a certain time because circulating IgE antibodies might be consumed by the allergic reaction, which would result in a false–negative test outcome. We investigated IgE concentrations during the first weeks after an insect sting in 31 patients with an unequivocal history of an anaphylactic reaction after a honeybee (n = 13) or Vespula (n = 18) sting. Blood samples for analysis of specific IgE concentrations (CAP system, Pharmacia Diagnostics, Sweden) were collected within 2 weeks and 5±2 weeks after the insect sting. 12/13 patients with honeybee venom and 14/18 patients with Vespula venom sensitization had CAP classes 1 or higher within the first 2 weeks. Those 5 patients with CAP class 0 within the first 2 weeks had detectable IgE concentrations a few weeks later. We conclude that testing for specific IgE to hymenoptera venoms is in most cases useful even during the first 2 weeks after the hymenoptera sting. This allows early decisions on further diagnostic procedures and the therapeutic way to choose. Patients with no detectable IgE should, however, be retested after a few weeks.

Interferon alpha and gamma have been used to treat several hepatic, hematological and oncological diseases for years. Recently, interferon beta has been introduced as a therapeutic agent in relapsing-remitting multiple sclerosis. A 41-year-old female patient with multiple sclerosis developed non-tender, palm-sized, cutaneous-subcutaneous, reddish infiltrates at the injection sites on her thighs after 8 weeks of treatment with subcutaneous interferon beta injections. Histopathology revealed a perivascular lymphoid infiltrate of the dermis and a subtle lobular lymphoid infiltrate of the subcutis. Interferon beta therapy was discontinued for 4 weeks. With topical corticosteroids, the skin lesions resolved. When subcutaneous injections were resumed at a reduced dose, only erythema around injection sites developed without induration or pain. Slight erythema and swelling at interferon beta injection site are frequent and rare cases of cutaneous necrosis have been described. However, no reports of large, painful, cutaneous-subcutaneous infiltrates after interferon beta therapy have been published.