Box 21. Recommendations on the duration of Hymenoptera VIT.

	Strength of consensus
47. In the absence of risk factors described below (recommendations 48 and 49), VIT can be discontinued after 3 – 5 years, provided that maintenance therapy has been tolerated without recurrent anaphylactic side effects.	Consensus
48. Permanent VIT can be considered in patients with, among others, – established mastocytosis, – cardiovascular or respiratory arrest due to Hymenoptera stings – other specific individual constellations indicating an increased individual risk (e.g., hereditary α-tryptasemia)	Strong
49. If insect exposure time is greatly increased and unavoidable (e.g., occupational), VIT can be given to adults until the end of intensive contact.	Consensus