title: When can immunotherapy for insect sting allergy be stopped?
abstract: BACKGROUND
  Stings by Hymenoptera (honey bees, vespids, ants) can cause systemic allergic reactions (SARs). Venom immunotherapy (VIT) is highly effective and reduces an allergic patient's risk of a recurrent SAR to less than 5-20%. The risk of a recurrent SAR to a re-sting decreases the longer VIT is continued. The recommended duration of VIT is at least 3 to 5 years.
  
  
  METHODS
  Risk factors for recurrent SARs to a sting after stopping VIT have been identified and discussed: Recommendations concerning stopping VIT: For patients without any of the identified risk factors, VIT should be continued for 5 rather than 3 years. In patients with definite risk factors, a longer duration of VIT has to be discussed before stopping it. In mast cell disorders, VIT for life is recommended. Because of the residual risk of SARs after VIT, all patients are advised to carry an epinephrine autoinjector indefinitely and to continue to take measures to avoid Hymenoptera stings.
authors.affiliation: Allergy Division, Department of Medicine, Ziegler Hospital, Bern, Switzerland. Electronic address: ulrich.mueller@spitalnetzbern.ch.
authors.forename: Ulrich R
authors.initials: UR
authors.lastname: Müller
authors.affiliation: Department of Dermatology and Allergy, Technical University, Munich, Germany, and Christine Kühne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Ring
mesh_terms: D000707:Anaphylaxis / Q000276:immunology / Q000628:therapy; D000818:Animals; D001180:Arthropod Venoms / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006927:Hymenoptera / Q000145:classification / Q000276:immunology*; D006967:Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000628:therapy*; D007299:Insect Bites and Stings / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000628:therapy*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012882:Skin Tests; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001180:Arthropod Venoms
keywords: Duration of VIT; Efficacy of VIT; Honey bees; Hymenoptera venom allergy; Risk factors for recurrence after VIT; Venom immunotherapy; Vespids