Table 11. Recommendations for prescribing AAIs in patients with insect venom allergy.

Absolute indication

– Children and adults with mastocytosis and/or elevated basal serum tryptase levels: before, during, and after completion of immunotherapy

– Untreated children and adults with more than cutaneous/mucosal SAR (i.e., grade I anaphylaxis) and at high risk of re-exposure

– During VIT: in children and adults with more than cutaneous/mucosal SARs (i.e., grade I anaphylaxis) when there are additional risk factors* for non-response to immunotherapy

– After completion of regular VIT in children and adults presenting with more than cutaneous/mucosal SAR (i.e., grade I anaphylaxis) and if there are additional risk factors* for non-response to VIT.

Relative indication

– Long distance to medical care and/or high risk of exposure and/or impaired quality of life

– After completion of regular VIT in children and adults with cutaneous/mucosal reactions (grade I) who are at increased risk of exposure and/or have had a short duration of immunotherapy (< 3 years)

– Individual patient request

*Risk factors in this context are severe insect venom anaphylaxis (grade III or IV), high risk of exposure (e.g., beekeeper), (repeated) systemic reaction under immunotherapy, mastocytosis, or elevated baseline serum tryptase above 20 µg/L . For adults, bee venom allergy is also considered a risk factor.