What VIT would you recommend in a patient who had grade 5 anaphylaxis to a stinging insect but negative IDT and serum IgE?

The short answer is none. Venom immunotherapy (VIT) is absolutely dependent on demonstrating specific IgE to the suspected agent. Without specific IgE, I would not recommend starting VIT.

When faced with the dilemma of post-insect sting anaphylaxis and negative skin tests(ST) and serum tests, the fi...

The short answer is that VIT cannot be recommended when the cause (and mechanism) cannot be identified. So it is necessary to re-examine the diagnosis, pursue further evaluation, and consider what options may exist for treatment.

First, was it anaphylaxis? What was the suspected culprit insect? Was t...