What are the European Academy of Allergy and Clinical Immunology guidelines on Hymenoptera venom allergy immunotherapy?

Updated: Nov 08, 2018
  • Author: Randy Park, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

Guidelines on hymenoptera venom allergy immunotherapy have been issued by the European Academy of Allergy and Clinical Immunology. [19] They are summarized as follows:

  • VIT recommended in adults with systemic sting reactions confined to generalized skin symptoms if quality of life is impaired
  • VIT recommended in children and adults with detectable sensitization and systemic sting reactions exceeding generalized skin symptoms
  • VIT not recommended in individuals with incidentally detected sensitization and no systemic symptoms
  • Factors not considered a higher risk of adverse events are severe initial sting reaction, high skin-test reactivity, and high venom-specific IgE levels
  • Pretreatment with H1 antihistamines recommended; reduces large local reactions and, to some extent, systemic adverse events
  • Recommended VIT duration is at least 3 years; 5 years recommended in patients with severe initial sting reactions
  • Lifelong VIT may be recommended in the following: (1) highly exposed patients with honeybee venom allergy, (2) patients with very severe initial sting reactions (Muller grade IV or grades III-IV, according to Ring and Messmer), and (3) patients with systemic adverse effects during VIT, as they are major risk factors for relapse
  • All available diagnostic tests, including determination of venom-specific IgE, IgG, basophil activation testing response, and allergen-blocking capacity, are not capable of estimating the individual risk for relapse
  • Most reliable method to evaluate effectiveness of VIT is sting challenges

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