Hymenoptera venom allergy (HVA) is a typical
IgE-dependent
allergy. Its diagnosis includes confirmation of the presence of specific
IgE antibodies to
venom allergens (vsIgE), and its treatment is based on developing of immunotolerance (venom immunotherapy, VIT). In most cases of
sting anaphylaxis, vsIgE can be found, in some, however, the
antibodies are undetectable, in spite of systemic reaction to
venom, which may be due to low specificity of diagnostic methods. Diagnostic methods might be improved by the use of recombinant
allergens which, being "uncontaminated" by other
venom constituents, allow for a precise setup of "individual allergogram." A diagnostic novelty is the
tryptase serum level assay that is capable of confirming ex-post
anaphylaxis and coincidence of
mastocytosis. The diagnostic procedures applied in
venom allergy make possible only to prove the existence of
allergy while it is impossible to estimate, on their basis, the risk of development and intensification of future reactions. New diagnostic concept that could supplement the imperfect diagnostic armamentarium is still lacking. Clinical practice has proven that VIT is a very effective method of protection of patients with
IgE-dependent wasp-
sting anaphylaxis, but both the effectiveness and safety of VIT in patients allergic to
bee venom are not optimal. The future of VIT is the use of modified, recombinant
allergens or their
peptide fragments, but clinical data on their effectiveness are unavailable as yet. The safety of VIT can be increased by means of introducing
premedication with
antihistamines.