Insect venom immunotherapy - whom to target and when to apply?

The article presents the most recent outlook on the subject of qualification and disqualification for hymenoptera venom specific immunotherapy (VIT). In comparison with the guidelines authorised by EAACI and AAAAI in previous years, recommending VIT in patients with large anaphylactic reactions (SYS III SYS IV), the AAAAI of 2007 and 2011 are marked by a further extension of clinical recommendation for venom immunotherapy to include two groups of patients: persons with SYS I and SYS II reactions over 16 years of age, and patients who have frequent disabling LLRs, particulary those with occupational exposure. At the same time strict contraindications for venom immunotherapy are retained in the small group of patients who do not present clinical or laboratory evidence of IgE-dependent venom hypersensitivity. In the article, up-to-date guidelines are presented in the following order: from absolute contraindications for immunotherapy, through situations that allow VIT, to absolute indications for VIT.