Abstract
Hymenoptera venom immunotherapy (VIT) is the only curative treatment for preventing effectively severe insect sting anaphylaxis. The overall cumulative risk of relapse at 10 years after discontinuing VIT is estimated at 17 %, but is mainly dependent on associated risk factors. The decision to discontinue or continue VIT depends on the patient's individual risk profile which takes into account the elements related to the initial sting reaction (severity, stinging insect), the characteristics of the patient himself (exposure, age, medical problems or treatments), the tolerance and efficacy of VIT and the presence or absence of certain biomarkers. Maintenance of an ongoing VIT is possible in case of treated severe cardio-respiratory diseases, stabilized systemic autoimmune diseases and tumors or in remission, primary or acquired immune deficits and immunomodulatory or immunosuppressive treatments. Lifelong VIT is indicated in case of clonal mast cell disorder or systemic mastocytosis, for any patient having experienced very severe or near-fatal hymenoptera venom anaphylaxis, and possibly also in case of hereditary alpha-tryptasemia, with the aim of protecting the patient from a severe, potentially fatal anaphylactic relapse.
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