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:
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VIT recommended in adults with systemic sting reactions confined to generalized skin symptoms if quality of life is impaired
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VIT recommended in children and adults with detectable sensitization and systemic sting reactions exceeding generalized skin symptoms
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VIT not recommended in individuals with incidentally detected sensitization and no systemic symptoms
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Factors not considered a higher risk of adverse events are severe initial sting reaction, high skin-test reactivity, and high venom-specific IgE levels
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Pretreatment with H1 antihistamines recommended; reduces large local reactions and, to some extent, systemic adverse events
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Recommended VIT duration is at least 3 years; 5 years recommended in patients with severe initial sting reactions
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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
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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
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Most reliable method to evaluate effectiveness of VIT is sting challenges
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Media Gallery
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Western paper wasp (Mischocyttarus flavitarsis) building a nest. By Sanjay Acharya (self-made at Sunnyvale, California, USA). Courtesy of Wikimedia Commons.
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Yellow jacket. By Richard Bartz, Munich aka Makro Freak (Own work). Courtesy of Wikimedia Commons.
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Fire ant bites. In less than 10 seconds, an unwary scientist was stung over 250 times on one leg when he carelessly knelt on a collapsed fire ant mound. The sterile pustules developed to this stage in 3 days. US Department of Agriculture. Courtesy of Wikimedia Commons.
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Fire ants. US Department of Agriculture. Courtesy of Wikimedia Commons.
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