Efficacy

We found one systematic review.44 In this review, studies of different designs were combined (randomised/non-randomised; placebo-controlled/ other control groups; before/after VIT trials). We have therefore included the results of the individual studies in the following sections. The reported pooled effect of all eight studies in the meta-analysis was a significant protective effect of VIT against systemic reaction after re-stings (odds ratio: 2-2, 95% confidence intervals 1-72-2-81).44

VIT versus placebo/no treatment/other treatment

We found two RCTs. In the first RCT, 59 adults with a history of systemic reactions after stings and a positive skin-prick test received VIT for 6-10 weeks.14 A significantly reduced incidence of systemic reactions after controlled sting challenges was observed in the VIT group compared with the placebo group (5% versus 58%) and with a group that received whole-body extract (64%). In the second trial, 74 children with a history of systemic reactions and a

How effective is symptomatic treatment after Hymenoptera stings?

positive skin-prick test were randomised to VIT or no treatment. Occurrence of field insect stings were observed for the subsequent 2 years. The difference in recurrence rates was not significant between the VIT group (6%) and the no-treatment group (17%).19

We found two non-randomised controlled trials. In the first,24 the incidence of recurrent systemic reactions was compared in 271 patients who underwent VIT, no VIT or incomplete VIT (stopped against physicians' advice). The incidence of systemic reactions after re-stings was 4% in the VIT group, 27% in the incomplete-VIT group and 50% in the no-VIT group. No statistical analyses were performed. In the second trial, VIT was compared with therapy with bee whole-body extract in 56 patients with beesting hypersensitivity. A significant reduction in the incidence of recurrent systemic reactions after field stings in patients treated with VIT was observed (25% versus 75%).45

Effect of VIT during ongoing VIT

We found 27 non-randomised non-controlled trials (before-after comparisons) that examined the recurrence rates of systemic allergic reactions to inhospital sting challenges or field stings in patients with a history of systemic reactions after Hymenoptera stings and venom sensitisation confirmed by positive skin-prick test and/or presence of specific IgE. The recurrence rate in re-stung patients ranged from 0% to 38% (one trial of 19 patients reported a rate of 58%).18,24,45-69

Recurrence of systemic reaction to stings after stopping VIT

We found 19 non-randomised non-controlled trials that examined the recurrence rates of systemic allergic reactions to inhospital sting challenges or field stings in patients with a history of systemic reactions after Hymenoptera stings and venom sensitisation confirmed by positive skin-prick test and/or presence of specific IgE. The recurrence rate in re-stung patients ranged from 0% to 27%24'48'53'60'70-82

In children

One randomised trial showed no significant effect of VIT in children.19 One observational prospective study in 29 honeybee-hypersensitive children and adolescents (4-20 years of age) reported recurrence rates of systemic reactions of 3% at 1 year and of 14% at 2 years after stopping VIT.82 Another study reported little benefit of VIT in children who had had only local reactions.26

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