A straightforward algorithm for diagnosing Hymenoptera venom allergy and identifying the relevant venom for immunotherapy

Background: Routine allergy diagnostic assessment relies on the patient's medical history, skin testing, and the detection of specific IgE (sIgE) in the serum. In addition, molecular allergy diagnostics and the basophil activation test (BAT) can be used; however, these additional tests are costly and sometimes time-consuming. Therefore, our objective was to identify the test with the highest sensitivity, determine the most effective combination of tests to enhance sensitivity, and develop a simple IgE ratio to distinguish between bee and vespid venom allergy in cases of double positivity. Methods: We retrospectively analyzed data from 190 bee venom-allergic and 809 vespid venom-allergic patients, along with 61 non-allergic subjects. Sensitivity and specificity were assessed for sIgE (ImmunoCAP), the intradermal test (IDT), and the BAT. Results: Applying a lower cut-off of 0.1 kU/L in patients with total IgE