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The Sting Challenge Test Shows High Negative Predictive Value in Patients Receiving Venom Immunotherapy

Alfaya Arias T1, Vega Castro A2,3, Garnica-Velandia D4,5, Macías Iglesias J1, Pereira González J6,7,8, Blanco Toledano N9,10, Puig Fuentes A9, Vicens-Novell G11, Bermúdez Bejarano M12, Tsopana A2, Marquès L4,5, González-de-Olano D13, Pérez-Fernández E14, Ruiz-León B9,10

1Allergy Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
2Allergy Service, Hospital Universitario de Guadalajara, Guadalajara, Spain
3IDISCAM (Instituto de Investigación de Castilla la Mancha), Toledo, Spain
4Allergy Service, Hospital Universitari Arnau de Vilanova, Lleida, Spain
5Instituto de Investigación Biomédica de Lleida, IRBLleida, Spain
6Allergy Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
7Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
8Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
9Allergology Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
10Maimonides Biomedical Institute of Córdoba (IMIBIC), Hospital Universitario Reina Sofía, University of Cordoba, Spain
11Allergy Department, Hospital Clinic, Barcelona, Spain
12Allergology Unit, Hospital Universitario de Jaén, Jaén, Spain
13Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
14Investigation Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain

J Investig Allergol Clin Immunol 2026; Vol. 36(3)
doi: 10.18176/jiaci.1086

Background: The sting challenge test (SCT) is regarded as the most reliable method for assessing the effectiveness of venom immunotherapy (VIT). However, its predictive value in patients undergoing VIT is unclear.
Objective: This study aims to evaluate the predictive value of the SCT.
Methods: A multicenter retrospective observational study was conducted on patients receiving VIT who underwent SCT. The study gathered data on patient demographics, diagnosis, immunotherapy details, outcomes of the SCT, and subsequent field stings.
Results: A total of 261 patients were included, and 372 SCTs were recorded. Most patients (75.1%) were men. Mastocytosis was confirmed in 7.7%. The final diagnosis was allergy to Apis mellifera (48.7%), Polistes dominula (36.8%), Vespula species (2.7%), and P dominula plus Vespula species (10.7%). SCTs were performed with Apis in 61.6% overall, Polistes in 34.1%, and Vespula in 4.3%. Most of the SCT results were negative (95.7%).
A total of 306 field stings were recorded for 146 patients (56.2%); of these, 95.1% were negative. Among these 146 affected patients, 137 had a negative SCT result, and 130 of these also had a subsequent negative field sting, resulting in a negative predictive value (NPV) for the SCT of 94.9%. Of the patients who experienced a field sting, 9 had a positive SCT, and only 3 had a positive field sting, resulting in a positive predictive value of 33.3%.
Conclusions: SCT is safe, and the high NPV emphasizes the usefulness of this test in assessing the effectiveness of VIT.

Key words: Hymenoptera venom allergy, Predictive value, Risk factors, Sting challenge test, Venom immunotherapy, Field sting