IT IS not clear what—or who—has provoked the ire of Howard S. Rubenstein, MD, but his communication, "Allergists Who Alarm the Public" (243:793-794, 1980), serves to provoke emotion rather than thought and fails to bring to the reader a balanced view of current knowledge regarding the diagnosis and treatment of insect sting allergy. Having worked on this problem for a number of years and having authored a recent report1 that demonstrated the efficacy of venom immunotherapy, we feel compelled to respond to his remarks.
Dr Rubenstein's major point seems to be that since so few people die of insect stings, physicians who recommend venom immunotherapy are unmitigated fearmongers. We agree that the reported mortality from insect stings is low but point out that the morbidity associated with systemic reactions to stings is much greater. Although adequate epidemiologic studies have not been reported, we have seen, from the Baltimore area alone,
Lichtenstein LM, Kagey-Sobotka A, Golden DBK, Valentine MD. Once Stung, Twice Shy: When Should Insect Sting Allergy Be Treated? JAMA. 1980;244(15):1683–1684. doi:10.1001/jama.1980.03310150019020
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