Hymenoptera (apid and vespid) allergy: update in diagnosis and management.

Allergic reactions to Hymenoptera stings range from large local reactions to life-threatening anaphylaxis. Over the last 20 years, significant progress has been made using venom extracts in the diagnosis and treatment of Hymenoptera allergy. Despite these advances, there is still room for improvement in increasing the sensitivity of venom allergen skin testing. The venom allergic patient with negative skin tests poses special problems in management. It is important to note their increased risk with a subsequent sting. Guidelines to be used in determining the duration of venom immunotherapy are still evolving. Knowledge of the risks of discontinuing venom immunotherapy and risk factors associated with anaphylaxis with subsequent stings are required to form an individualized approach to treatment.