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Because reactions to the venom of stinging insects are potentially life threatening, we emphasise that, despite the absence of systematic and reliable evidence, systemic reactions should be treated as one would treat anaphylaxis from any other cause. An emergency kit for self-medication is recommended for patients with a known history of systemic reactions.

• We found good evidence evaluating the effect of VIT. However, because of the potentially life-threatening nature of Hymenoptera venom hypersensitivity, it seems unethical to perform double-blind, placebo-controlled trials. Therefore our evaluation had to be based mainly on lower-level evidence - non-randomised, non-controlled interventional studies.

• We found good evidence that pretreatment with oral antihistamines in VIT reduces local reactions, but inconclusive evidence that it reduces systemic reactions.

Golden DBK, Addison BI, Gadde J et al. Prospective observations on stopping prolonged venom immunotherapy.

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