Venom immunotherapy, already shown to be highly effective in prevention of insect sting anaphylaxis in previously sensitized patients, remains effective but brings little benefit to patients age 2-16 years whose systemic reactions were limited to the skin. Lack of benefit in this group stems from a repeat reaction rate in unimmunized patients much lower than expected from previous experience with insectallergic adults. This disparity will allow us to probe whether the low reaction rate is a function of age, reaction type (cutaneous vs. respiratory, mucosal or cardio-vascular) or another variable. Additional goals include exploration of whether in vivo or in vitro parameters of decline in anti-venom IgE antibodies can be correlated with clinical evidence of attenuation of the venom-allergic state. We shall continue to document the natural history of insect sting allergy without immunotherapeutic intervention in mildly affected children.
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