Published: October 2025
The Hymenoptera order comprises more than 100,000 known species of insects worldwide.1 Some components of Hymenoptera venom are potential allergens and can cause local and/or systemic allergic reactions after IgE-mediated sensitisation.1
Hymenoptera venom allergy should not be underestimated
After an initial sting, the immune system of affected people may respond by producing allergen-specific IgE (sIgE) antibodies. Subsequent stings can trigger a more rapid inflammatory response. Hymenoptera venom allergy is one of the most serious IgE-mediated hypersensitivities due to the high risk of severe and even fatal anaphylaxis, causing 48% of severe anaphylactic reactions occurring in European adults, and 20% of those occurring in children.2
The role of specific IgE testing in Hymenoptera venom allergy’s diagnosis
Venom allergy diagnosis is supported by detection of sIgE antibodies using whole extracts or individual allergenic venom components that are found within the whole extract. Several honeybee and vespid allergens have been characterized and are available as recombinant antigens for component-resolved diagnostics (CRD).3
CRD further supports to discriminate genuine sensitization from interspecies cross-reactivity.
Accurate identification of allergy-eliciting stinging insect(s) is essential to ensuring effective management of Hymenoptera venom-allergic individuals with venom-specific immune therapy (VIT). Diagnostic testing using whole-venom extracts with skin tests and serologic-based analyses are considered the first level of discrimination for honeybee versus vespid venom sensitization in patients with a positive clinical history. As a second-level evaluation, serologic testing using recombinant allergens for component resolved diagnostics can further discriminate genuine sensitization (honeybee venom: Api m 1, 3, and 10 and yellow jacket venom/Polistes dominula venom: Ves v 1 and Ves v 5/Pol d 5) from interspecies cross-reactivity (hyaluronidase: Api m 2 and dipeptidyl peptidase: Api m 5).3
Up to 50% of venom allergic patients test positive for both bee and wasp venom4
Component resolved diagnostics using recombinant venom allergens may improve specificity5—increasing the likelihood of successful venom immunotherapy.
Identifying sIgE responses to specific molecular targets with CRD helps fine-tune the diagnosis by distinguishing species-specific, co-reactive, or cross-reactive sensitizations. 3
Allergenic components from honeybee and vespid venom
ImmunoCAPTM specific IgE portfolio for Hymenoptera venom allergy comprises of Honeybee venom, common wasp (Yellow jacket) venom and Paper wasp venom.
Honeybee venom |
i1 |
Common wasp Yellow jacket venom (Vespula vulgaris) |
i1 | Paper wasp venom (Polistes dominula) |
i1 | |
|---|---|---|---|---|---|---|
Differentiating marker allergen |
Api m 1 (Phospholipase A2) Api m 3 (Acid phosphatase) Api m 10 (Icarpin) |
i208 i215 i217 |
Ves v 1 (Phospholipase A1) Ves v 5 (Antigen 5) |
i211 i209 |
Pol d 5 (Antigen 5) |
i210 |
Cross reactive allergens |
Api m 2 (Hyaluronidase) Api m 5 (Dipeptidyl peptidase) |
i214 i216 |
How to test for Hymenoptera venoms allergy with ImmunoCAPTM Specific IgE tests.
Testing with stinging insect components can help to:
Discriminate between species specific sensitization and cross-reactivity2,3
Identify culprit venom(s)2,3
Facilitate accurate prescription
of VIT3
The role of tryptase in insect venom immunotherapy choice
For patients with a history of severe insect sting anaphylaxis and negative skin and serum test results for venom, the diagnosis can further be refined with serum tryptase testing.5
An elevated baseline tryptase level may be a significant risk factor for repeated severe reactions to venom stings in conjunction with other clinical findings which may indicate the need for VIT.1,6,7
Tryptase helps to guide venom immunotherapy treatment1
Venom allergic patients with underlying mastocytosis should be considered for lifelong immunotherapy, as there is an increased risk of relapse if VIT is discontinued.6,8 There is a consensus among leading allergy organizations on the value of tryptase when testing.
Tryptase should be measured in patients with a history of a severe sting reaction.
– EAACI, AAAAI, WAO, ICON2
Tryptase should be measured in patients before starting VIT.
– EAACI, AAAAI, WAO, ICON7
In a nutshell, Tryptase test results can be a significant help to:
- Support the clinical assessment on need for therapy6
- Guide VIT treatment7
- Decide on lifelong treatment6,8
