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Background:Venom allergy is significantly underestimated in China.Venom-specific IgE may not provide accurate clinical reactions.Our conducted retrospective analysis observes altative diagnostic considerations in assessing confirmation and severity of honeybee venom allergy.Methods:Retrospective review of honeybee venom allergy versus nonallergy patients presented with positive honeybee venom (i1) sIgE results.According to clinically observed reactions caused by a honeybee sting,patients were divided into three groups.Patient residence and exposure types were analyzed.The sIgE/T-IgE among allergy and control groups was compared.Results:Gender ratio male:female was 32:22;median age was 39 years (31,50).48％ (26/54) of patients live in urban areas,52％ (28/54) in rural areas.Based on bee sting reactions,patients were divided into common localized reactions (32/54),large localized reactions (7/54),and systemic reactions (15/54).In the systemic reaction group,patients presented as Type Ⅱ (6/15),Type Ⅲ (6/15).There is significant difference (P ＜ 0.001) between the three groups in regards to exposure types.In the systemic reaction group,8.7％ (13/15) of patients are beekeepers.A significant difference (P ＜ 0.001) was observed between allergic and control groups based on sIgE/T-IgE results.As well as significant difference observed between the systemic reaction group to the other two reaction groups in regards to sIgE/T-IgE results.Six systemic reaction patients presented with large localized reactions before onset of system symptoms 1 month to l year of being stung.Conclusions:Occupational exposure is the most common cause in honeybee venom allergy induced systemic reactions.The use of sIgE/T-IgE results is a useful diagnostic parameter in determining honeybee venom allergy.