New directions in diagnostic evaluation of insect allergyGolden, David B.K.Current Opinion in Allergy & Clinical Immunology: August 2014 - Volume 14 - Issue 4 - p 334–339 doi: 10.1097/ACI.0000000000000072 ANAPHYLAXIS AND INSECT ALLERGY: Edited by Jeffrey G. Demain and Gianenrico Senna Abstract Author Information Purpose of review: Diagnosis of insect sting allergy and prediction of risk of sting anaphylaxis are often difficult because tests for venom-specific IgE antibodies have a limited positive predictive value and do not reliably predict the severity of sting reactions. Recent findings: Component-resolved diagnosis using recombinant venom allergens has shown promise in improving the specificity of diagnostic testing for insect sting allergy. Basophil activation tests have been explored as more sensitive assays for identification of patients with insect allergy and for prediction of clinical outcomes. Measurement of mast cell mediators reflects the underlying risk for more severe reactions and limited clinical response to treatment. Summary: Measurement of IgE to recombinant venom allergens can distinguish cross-sensitization from dual sensitization to honeybee and vespid venoms, thus helping to limit venom immunotherapy to a single venom instead of multiple venoms in many patients. Basophil activation tests can detect venom allergy in patients who show no detectable venom-specific IgE in standard diagnostic tests and can predict increased risk of systemic reactions to venom immunotherapy, and to stings during and after stopping venom immunotherapy. The risk of severe or fatal anaphylaxis to stings can also be predicted by measurement of baseline serum tryptase or other mast cell mediators. Johns Hopkins University, Baltimore, Maryland, USA Correspondence to David B.K. Golden, MD, Associate Professor of Medicine, Johns Hopkins University, 7939 Honeygo Blvd, #219, Baltimore, MD 21236, USA. E-mail: firstname.lastname@example.org Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.