New Allergy Consult

New Allergy Consult:

Problems:  1.  Venom allergy and immunotherapy follow-up.
-The patient has been undergoing venom immunotherapy since early 2019 for allergies to yellow jacket, paper wasp, yellow hornet, and white-faced hornet venoms. Over nearly five years of monthly injections, there have been no systemic or anaphylactic reactions. The only symptoms reported have been mild local reactions, including pruritus and localized swelling at the injection site, which have not been severe. The patient has not experienced any insect stings during the course of immunotherapy.

Past Medical History: 
The patient has been receiving venom immunotherapy since early 2019. There is no history of mast cell disorders.

Investigations
The patient’s recent specific immunoglobulin E levels were as follows: yellow jacket 5.05 kU/L (previously 2.21), paper wasp 4.19 kU/L (previously 2.82), yellow hornet 2.84 kU/L (previously 6.57), and white-faced hornet 3.73 kU/L. These values are within the expected range for a patient undergoing venom immunotherapy. The patient’s serum tryptase level is within normal limits.

Impression and recommendations:  1.  Venom immunotherapy follow-up.
-The patient is approaching five years of continuous venom immunotherapy, with no systemic or anaphylactic reactions and only mild local symptoms. Specific IgE levels have shown expected fluctuations, and serum tryptase is normal. The patient meets criteria for safely discontinuing immunotherapy.
-Plan: Schedule a final round of bloodwork in October or November, including a possible repeat skin test. If results are stable, discontinue venom immunotherapy by the end of the year or early next year. Educate the patient on the continued need to carry an EpiPen as a precautionary measure. Follow up with the lab requisition this fall and review results at the next visit.