Background The sting challenge test (SCT) is regarded as the most reliable method for assessing the effectiveness of venom immunotherapy (VIT). However, its predictive value in patients undergoing VIT is still unclear. This study aims to evaluate the predictive value of the SCT. Methods A multicenter retrospective observational study was conducted on patients receiving VIT who underwent SCT. The study gathered data on patient demographics, diagnosis, immunotherapy details, outcomes of the SCT and their comparison to subsequent field sting (FS) results. Results A total of 261 patients were included, and 372 SCT were recorded. The majority of the patients (75.1%) were men. A diagnosis of mastocytosis was confirmed in 7.7%. The final diagnoses were allergy to Apis mellifera (48.7%), Polistes dominula (36.8%), Vespula spp. (2.7%) and Polistes dominula plus Vespula spp. (10,7%). Sting challenge tests were performed with Apis in 61.6% of the overall tests, Polistes in 34.1% and Vespula in 4.3%. The majority (95.7%) of the SCT were negative. Regarding FS, 146 patients (56.2%) experienced 306 FS of which 95.1% were negative. Among these 146 patients, 137 had a negative SCT, and 130 of these also had a subsequent negative FS, resulting in a 94.9% of negative predictive value (NPV) of the test. Of the patients who experienced FS, 9 had a positive SCT and only 3 of them had a positive FS, resulting in a positive predictive value of 33,3%. Conclusions SCT is a safe procedure, and its high NPV emphasizes the usefulness of this test in assessing the effectiveness of VIT.