For patients that have experienced a systemic allergic reaction induced by Hymenoptera venom, venom immunotherapy (VIT) dramatically reduces the risk of subsequent reactions. 1 Similarly, whole body extracts (WBE) are used in immunotherapy for Solenopsis (fire ant) species allergy with improvements in prognosis comparable to VIT. 2 Among the barriers to diagnosis and management of insect hypersensitivity is the need for allergy testing for the selection of immunotherapy extracts prior to immunotherapy. 3 Testing is generally performed after a theoretical 6-week refractory period following an anaphylactic event, by an allergist that performs and interprets venom allergy testing varies. Testing options include skin and serum tests, with current guidelines recommending skin testing followed by serum testing when results are negative. At some centers, the order of testing has been reversed for reasons that include time constraints and costs that limit skin testing along with increased sensitivity of serum testing.Allergists rely on venom allergy testing to help select the appropriate extracts for use in desensitization. Allergists may be hesitant to narrow the scope of testing based on patient history. This hesitance stems from a single study, which questioned the reliability of patient-reported information concerning insect taxonomy. It is worth noting that this study primarily considered patient knowledge of insects rather than the expertise of physicians in interpreting patient history. 4 Current guidelines do recognize the potential of history-based approaches, particularly when the identity of the offending insect is unequivocal. 5 For instance, the presence of a sterile pustule following a sting is widely regarded as pathognomonic for fire ant stings. In cases where expert identification of the insect is feasible, such as when a specimen is brought in by the patient, this further supports restricting the scope of venom allergy testing. Allergists that infrequently perform venom immunotherapy may be unaware of the relative usefulness of history elements in selecting venom extracts for testing and desensitization. Our study was conducted to determine how often elements of the history could be used to restrict the number of taxa for which patients were desensitized in a referral center for patients with venom-induced anaphylaxis.After approval by the Ochsner health system IRB with a waiver of informed consent due to minimal risk, we conducted a retrospective chart review of 52 patients who initiated VIT with an ultrarush induction protocol at our New Orleans center from 2016 to 2022. Patients were identified using CPT codes (9513X, 9514X, or 95170) indicating immunotherapy with Hymenoptera venom extracts or fire ant WBE. All patients who underwent ultrarush were included, with no patients excluded.The time elapsed between the initial anaphylactic reaction and the initiation of immunotherapy was determined. For adult patients with a history of reaction in childhood (without specified age), the date the patient turn...
