Further Comments on Insect Sting Allergy-Reply

Howard J. Schwartz, MD
Arch Intern Med. 1985;145(2):368-369. doi:10.1001/archinte.1985.00360020212044.
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—Although it seems that Dr Bookman and I agree about the fact that one must use skin tests to validate a clinical history, I do not agree with him that "when the skin test disagrees with clinical facts it should be disregarded," and I would not use venom immunotherapy on a patient with negative skin tests and negative radioallergosorbent tests, despite the history, unless there were a positive controlled sting challenge. However, I would agree with prescribing an emergency kit with epinephrine and antihistamines for such a patient. I must point out that my use of the term validate meant corroborate; thus I do use the test for corroborative purposes, as does Dr Bookman, but we perhaps differ in how we precisely choose patients for venom immunotherapy: most authorities will look for skin test positivity as a precondition for venom therapy; one indication for eventual cessation of immunotherapy is the


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