Risk of recurrent systemic allergic reaction after stopping venom immunotherapy

Elevated in:

Adults compared with children

Patients allergic to honey bee venom compared with those with vespid venom allergy

Patients with severe pretreatment SARs

Patients with SARs during VIT to treatment injections or re-stings

VIT duration less than five years of maintenance VIT

Elevated baseline serum tryptase

Mastocytosis

Patients with frequent exposure, such as gardeners, farmers, and beekeepers

Possibly elevated in:

Persistent high sensitivity on intradermal skin testing or in vitro testing for venom-specific IgE

Patients with underlying cardiovascular or respiratory disease

Patients taking medications, such as ACE inhibitors and/or beta-blockers

Not influenced by:

Sex

Atopy

Venom-specific IgG level at discontinuation of VIT

Diminished if:

Skin tests and venom-specific IgE negative at discontinuation of VIT

SAR: systemic allergic reaction; VIT: venom immunotherapy; IgE: immunoglobulin E; ACE: angiotensin-converting enzyme; IgG: immunoglobulin G.

Adapted from: Golden DB, Demain J, Freeman T, et al. Stinging insect hypersensitivity: A practice parameter update 2016. Ann Allergy Asthma Immunol 2017; 118:28.

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Risk of recurrent systemic allergic reaction after stopping venom immunotherapy