The first step in establishing whether a patient is allergic to insect stings is a detailed history. Once the type of insect and severity of the reaction have been characterized, allergy skin testing may be performed to confirm whether or not the patient is allergic to any of the stinging insects. All people, regardless of any age, should undergo testing if they have symptoms of a systemic reaction after a sting. This group stands to benefit most from accurate diagnosis and treatment, as 60–70% of patients with a history of a systemic reaction are at risk for similar future reactions after stings.
While the chance of a reaction with a future sting does decrease over time, it still remains at about 20% many years after the last sting. Allergy testing to insect venom is not needed if a person was stung in the past but never had any allergic symptoms, if a child under 16 years of age has had only skin symptoms such as hives and/or swelling after a sting, or if a child or adult has had only a large local reaction. However, in some cases a physician may elect to test these patients, particularly if they are at high risk for future stings. In addition, people should not be tested if they have never been stung or if there is only a family history of a reaction to a sting.