Indications for indefinite venom immunotherapy

Life-threatening pretreatment SAR

High likelihood of recurrent stings in the future due to occupational or recreational activities*

Honeybee venom allergy and a high likelihood of recurrent stings in the future (eg, beekeepers and their family members)

Significant cardiovascular disease and/or concomitant use of ACE inhibitors or beta-blockers

Recurrent SARs to VIT injections or recurrent SARs to re-stings during maintenance VIT

Requirement for higher venom doses to achieve adequate protection

Limitations in work or leisure activities due to anxiety concerning the residual risk of a repeat reaction

Known mast cell disorders or an elevated baseline level of serum tryptase

Patients with one or more of the above characteristics are at increased risk for recurrent SARs after stopping VIT or for a poor outcome resulting from anaphylaxis, and are therefore candidates for indefinite therapy. The decision to continue or stop VIT should also incorporate the patient's comfort with risk and other preferences.

SAR: systemic allergic reaction; VIT: venom immunotherapy; ACE: angiotensin-converting enzyme.
* May not be an independent indication if initial SAR was mild.

Graphic 121524 Version 1.0

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Indications for indefinite venom immunotherapy