IGHE and allergic disease: In addition to primary allergy to more than one venom, multiple positive test results with limited or no clinical relevance can be caused by: i) IgE antibodies directed to protein epitopes on homologous allergens present in the venoms, ii) sIgE to clinically irrelevant cross-reactive carbohydrate determinants (CCDs), and iii) asymptomatic sensitization (42).