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Background  Venom immunotherapy (VIT) is highly effective in preventing allergic reactions to insect stings, but the appropriate venom must be used to achieve clinical protection. In patients with multiple positive results to venoms, molecular allergy diagnostics or CAP-inhibition may identify the causative venom. Concerning allergy to venom from  Polistes spp . it has been proposed that only the European species  P .  dominulus  should be used for VIT. However, this recommendation is not present in any international guideline. Using both laboratory and clinical data, we aimed to evaluate the reliability of this proposal.    Methods  We performed an  in vitro  study using CAP-inhibition to determine sensitization of 19 patients allergic to  Polistes  venom. The clinical study included 191 patients with positive tests to  Polistes  treated with VIT, 102 were treated with  P .  dominulus  and 89 were treated with a mix of American  Polistes  (mAP).    Results  The difference in % of inhibition was significant concerning inhibition of  P .  dominulus  sIgE by  P .  dominulus  venom (79.8%) compared with inhibition by mAP venom (64.2%) and not significant concerning the inhibition of mAP sIgE by  P .  dominulus  venom (80.1%) and by mAP venom (73.6%). Instead, the clinical protection from stings was not statistically different between the two kinds of venom.    Conclusion  The data from CAP inhibition would suggest that the choice of either  P .  dominulus  venom or mAP venom for VIT is appropriate in patients with CAP inhibition higher than 70%, but the clinical data show the same odds of protection from stings using for VIT P. dominulus or mAP venom.

Which immunotherapy product is better for patients allergic to Polistes venom? A laboratory and clinical study