[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-440191-105":3,"detail-sidebar-cat-0-en-105":80,"doc-detail-440191-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","successful-venom-immunotherapy-in-a-child-with-anaphylaxis-to-hymenoptera-skin-testing","Successful venom immunotherapy in a child with anaphylaxis to Hymenoptera skin testing","","Successful venom immunotherapy (VIT) was achieved in a 10-year-old boy who experienced anaphylaxis after Hymenoptera skin testing and tolerated a modified rush VIT protocol. The report describes adjunct omalizumab therapy, started before VIT and continued through buildup and several months of maintenance, then discontinued while maintaining continued tolerance. Emergency treatment after the initial sting included epinephrine, bronchodilation, and corticosteroids, followed by diagnostic testing to identify specific Hymenoptera sensitization.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/successful-venom-immunotherapy-in-a-child-with-anaphylaxis-to-hymenoptera-skin-testing/440191/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/successful-venom-immunotherapy-in-a-child-with-anaphylaxis-to-hymenoptera-skin-testing/440191.png","ImageObject",300,407,{"name":42,"@type":43},"Guten tag","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-09-30","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":26},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"What allergic condition is described in the child in this report?","Question",{"text":62,"@type":63},"The child had anaphylaxis related to a Hymenoptera sting and reacted in the context of Hymenoptera skin testing, prompting venom immunotherapy planning.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"How was venom immunotherapy administered in this case?",{"text":67,"@type":63},"The patient underwent a modified rush venom immunotherapy protocol with starting doses substantially lower than the intradermal dose that triggered anaphylaxis.",{"name":69,"@type":60,"acceptedAnswer":70},"What role did omalizumab play during venom immunotherapy?",{"text":71,"@type":63},"Omalizumab was used as adjunct therapy, initiated before VIT and continued through buildup and maintenance for several months; it was later discontinued while the child remained tolerant of ongoing maintenance VIT.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},440191,1790794553,{"code":4,"msg":81,"data":82},"success",[83,87,91,95,100,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":88,"show_sort_weight":89,"slug":90},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":92,"show_sort_weight":93,"slug":94},"Exam",70,"exam",{"id":96,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},5,"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":96,"slug":129},19,"General","general",{"code":4,"msg":81,"data":131},{"doc_id":78,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":26,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":110},687212321768,"https://ap-avatar.wpscdn.com/avatar/a0010bdbe886d2fe77?x-image-process=image/resize,m_fixed,w_180,h_180&k=1789897067658708522","Successful venom immunotherapy in a child   \nwith anaphylaxis to Hymenoptera skin testing  \nEllen Conroy, MD,a,b Mandi Bailey, BA,c Jackie Garrett, MD,d andAna Broyles, MDa,b Boston, Amherst, and West Springfield, Mass  \nOmalizumab has been used during venom immunotherapy primarily for high-risk adult patients. We report a similar approach in a child with anaphylaxis in response to Hymenoptera skin testing who successfully tolerated modified rush venom immunotherapy with concurrent use of omalizumab. (J Allergy Clin Immunol Global 2026;5:100619.)  \nKey words: Stinging insect, anaphylaxis, Hymenoptera, omalizumab, pediatric, skin testing, venom immunotherapy, desensitization  \nSystemic reactions to stinging insects occur in up to 0. 8% of children and 3% of adults.1 Venom immunotherapy (VIT) is effective in reducing the occurrence and severity of systemic reactions in response to insect stings.2 Systemic allergic reactions are possible side effects of VIT. Omalizumab, an anti-IgE mAb, has been used as adjunct therapy to decrease such reactions. This has been reported mainly in adults and adolescents with recurrent systemic reactions to VIT or mastocytosis.3-8 There is 1 report of this approach being used in a younger child.9 None of the pediatric reports include VIT protocols. In this case report, we describe successful VITin a younger child with anaphylaxis toa Hymenoptera sting and in response to skin testing. The patient tolerated rush VIT with concomitant use of omalizumab, which was later discontinued with continued tolerance of maintenance VIT. Informed assent and consent to publish this case were obtained from the patient and his parents.  \nA 10-year-old boy presented for consultation following insect sting anaphylaxis. Within 15 minutes ofa yellowjacket sting (per the family’s identification) on the ear, the patient developed facial swelling, cough, nausea, and generalized urticaria. The family called emergency medical services, who administered intramuscular epinephrine and transported him to the emergency department. According to the patient’s family, he then developed wheezing and loss of consciousness. After a second  \nFrom athe Division of Immunology, Department of Medicine, Boston Children’s Hospital, Boston; bHarvard Medical School, Boston; cAmherst College; and dAgape Allergy & Immunology Associates, West Springfield.  \nReceived for publication June 8, 2025; revised August 23, 2025; accepted for publication September 10, 2025.  \nAvailable online December 1, 2025.  \nCorresponding author: Ana Broyles, MD, 300 Longwood Ave, Boston, MA 02115. E-mail: [ana.broyles@childrens.harvard.edu](ana.broyles@childrens.harvard.edu).  \n The CrossMark symbol notifies online readers when updates have been made to the article such as errata or minor corrections  \n2772-8293  \n© 2025 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology. This is an open access article under the CC BY-NCND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)) .  \n[https://doi.org/10.1016/j.jacig.2025.100619](https://doi.org/10.1016/j.jacig.2025.100619)  \nAbbreviations used sIgE: Specific IgE  \nVIT: Venom immunotherapy  \nadministration of intramuscular epinephrine, albuterol, and methylprednisolone, the boy showed improvement. An acute tryptase level was not obtained.  \nSubsequent testing showed a normal baseline level of serum tryptase; an elevated level of total IgE; and elevated levels of specific IgE (sIgE) to honeybee, yellow jacket, yellow hornet, white-faced hornet, and paper wasp venom (Table I) . Skin prick testing (1 μg/mL) was negative for all 5 Hymenoptera species. Given the patient’s relatively low level sIgE to paper wasp venom, intradermal testing was performed only to paper wasp venom (0 .001 μg/mL) . A local reaction developed, and before the final measurement the patient developed facial hives, itchy feet, and lethargy 5 minu","cbCaiuzHL0snpvmK","https://ap.wps.com/l/cbCaiuzHL0snpvmK","pdf",199259,"English","# Case report overview\n## Initial sting and emergency management\n## Diagnostic workup and skin testing\n## Treatment plan: omalizumab and modified rush VIT\n## VIT course and tolerance","[{\"question\":\"What allergic condition is described in the child in this report?\",\"answer\":\"The child had anaphylaxis related to a Hymenoptera sting and reacted in the context of Hymenoptera skin testing, prompting venom immunotherapy planning.\"},{\"question\":\"How was venom immunotherapy administered in this case?\",\"answer\":\"The patient underwent a modified rush venom immunotherapy protocol with starting doses substantially lower than the intradermal dose that triggered anaphylaxis.\"},{\"question\":\"What role did omalizumab play during venom immunotherapy?\",\"answer\":\"Omalizumab was used as adjunct therapy, initiated before VIT and continued through buildup and maintenance for several months; it was later discontinued while the child remained tolerant of ongoing maintenance VIT.\"}]","Successful venom immunotherapy in a child with anaphylaxis to Hymenoptera skin testing | PDF",1790691449]