Comparative evaluation of Soluprick, skin prick testing and intradermal testing in Apis mellifera and Vespula species venom allergy: a multicenter real-life study

SUMMARY

Background. Skin testing is a cornerstone of the diagnostic work-up of Hymenoptera venom allergy. However, evidence comparing high-concentration venom prick testing (Soluprick 300 μg/mL) with others skin prick testing (SPT) and intradermal testing (IDT) remains limited. Methods. In this multicenter retrospective study, 123 consecutive adult patients evaluated for Hymenoptera venom allergy at three tertiary allergy centers were included. Skin test responses to Apis mellifera and Vespula spp. venoms were assessed using Soluprick 300 μg/mL, SPT (100 μg/mL), and IDT (0.1 and 1 μg/mL). Agreement between methods was assessed using concordance correlation coefficients and Bland-Altman plots, while systematic differences were evaluated using paired Wilcoxon signed-rank tests. Results. A total of 123 patients were included, of whom 32 (26.0%) were receiving venom immunotherapy. For Apis mellifera venom extract, Soluprick showed good comparability with conventional SPT 100 μg/mL (CC = 0.77). In contrast, concordance between Soluprick and IDT was poor, with significant systematic bias and significant paired differences (p < 0.001). For Vespula spp. venom extract, agreement between Soluprick and all alternative methods (including conventional SPT and IDT) was low. In addition, no significant differences in skin test responses were observed according to VIT status. Conclusions. Soluprick cannot be considered interchangeable with IDT. While it showed good comparability with conventional SPT 100 μg/mL for Apis mellifera venom, agreement was substantially lower for Vespula spp. These findings suggest that Soluprick should not be considered interchangeable with IDT in routine clinical practice.

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