We present our study of four patients with occupational type I allergy to red midge larvae (group 1) who we compared with seven individuals also sensitized to red midge larvae but who had not apparently been exposed to them (group 2). All patients showed elevated specific IgE against Chironomus thummi, and positive skin prick tests (SPT) and provocation tests with red midge larvae. We carried out SPT with Dermatophagoides pteronyssinus, Acarus siro, shrimp, cockroach and common mosquito (Culex pipiens) and specific serum IgE was also determined. The red midge larvae wheal size was significantly larger in group 1 (x = 149.2 mm2) than in group 2 (x = 18 mm2). Significant differences between levels of IgE anti-C. thummi were also found in group 1 (x = 52.12 kU/l) and in group 2 (x = 1.5 kU/l). The patients in group 2 had high levels of specific IgE against other allergens (D. pteronyssinus, shrimp and/or common mosquito) and had positive SPTs with these allergens, while the patients in group 1 were only sensitized to chironomids. The IgE-immunoblotting profile was quite different in both groups. The patients in group 1 seemed to have IgE against Chi t 1, the main Chironomus allergen, while the patients in group 2 had IgE against several protein bands in Chironomus, mosquito, shrimp and D. pteronyssinus extracts, some of them with equivalent molecular weights. We believe that the patients in group 2 were sensitized to Chironomus as a result of cross-reactivity with other insect or crustacean species.