Specific immunotherapy for Hymenoptera venom anaphylaxis: current issues

Venom immunotherapy (VIT) protects patients with honeybee or vespid venom allergy in up to 100% from further sting anaphylaxis. Basically, contraindications of specific immunotherapy apply also to VIT. However, careful risk-benefit assessment is necessary to decide whether performing VIT despite a contraindication or refraining from it is less harmful to the patient. As patients with mastocytosis frequently develop life-threathening sting anaphylaxis, it has to be discussed to treat them with VIT also without prior sting anaphylaxis in case of Hymenoptera venom sensitization. Repeated systemic reactions to VIT may neces-sitate its discontinuation. In this situation concomitant administration of the anti-IgE antibody omalizumab seems a promising approach to achieve tolerance of VIT. For patients who need lifelong VIT (e.g., in mastocytosis), longer intervals between injections would make prolonged treatment more acceptable. However, the efficacy of injection intervals of more than six weeks needs to be assessed by adequate studies. Today, at most 10% of patients with Hymenoptera venom all er gy are provided with adequate care-physicians' and patients' knowledge of the excellent therapeutic options for this condition have to be improved.