When to start and when to stop venom immunotherapy?

The efficacy of hymenoptera venom immunotherapy is well documented. The indication for this treatment is based on the history of a systemic allergic reaction to a sting by a honey bee or a vespid, the evidence for IgE-mediated allergy in skin tests or serologic examinations and our knowledge of the natural history of this allergy. The indication is given in the presence of a history of severe reaction with cardiovascular or respiratory symptoms and positive tests, Patients with mild to moderate reactions with predominant cutaneous symptoms and positive tests are only treated if they are heavily exposed and have developed repeated reactions. The optimal duration of venom immunotherapy has been analyzed in a number of prospective studies. In all of these the vast majority (> 80%) of those restung after discontinuation of an immunotherapy of at least 3 years' duration was still protected. Relapses occurred more frequently in patients with a history of very severe pretreatment reaction and in those who developed systemic allergic symptoms during immunotherapy, either to treatment injections or to a sting by the insect in question. A treatment of 5 years was superior to a treatment of only 3 years. Therefore, a duration of 5 years is generally recommended, an even more prolonged treatment for patients with a history of very severe reactions or of allergic reactions during immunotherapy. (C) 2002 Editions scientifiques et medicales Elsevier SAS.