Brown 2003.

Methods	This was a randomised, double‐blind, placebo‐controlled, parallel‐group trial.
Participants	This trial was conducted in Australia. The participants were adults aged 18 to 63 years. The total number of participants was 68. The total number of participants in the treatment group was 35 (22 men). The total number of participants in the control group was 33 (18 men). The species of insect venom that the participants were allergic to was Myrmecia pilosula (M. pilosula) venom (ant venom). Inclusion criteria of the trial History of 1 or more Mueller grade II to IV reactions to ant venom (M. pilosula) and a positive intradermal skin test to M. pilosula venom Exclusion criteria of the trial ACE inhibitor or β‐blockers therapy Hypertension Heart disease Poorly‐controlled lung disease People with negative skin tests
Interventions	Treatment: subcutaneous injections of VIT VIT Manufacturer: NSL Health Ltd., Melbourne, Australia Duration: 4 to 5 months Updosing: Outpatient cluster hyposensitisation regimen (10 visits) Maintenance dose: 100 µg monthly Control: subcutaneous placebo (histamine acid phosphate)
Outcomes	Outcomes of the trial 1. Systemic reaction to insect sting challenge             2. Fatal systemic reaction to insect sting challenge              3. Adverse events to immunotherapy
Notes	This study was funded by NSL Health Ltd. (VIT manufacturer), the Department of Health and Human Services Tasmania, and Royal Hobart Research Foundation.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Random number‐based sequential allocation was done by a third party.
Allocation concealment (selection bias)	Low risk	This was done by a third party.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Participants lost to follow up or excluded were accounted for along with participants followed to designated follow‐up periods (0 out of 35 participants in the treatment group and 4 out of 33 participants in the control group).
Selective reporting (reporting bias)	Low risk	The specified outcomes in the methodology were reported in the results section.
Other bias	Low risk	‐
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Packs were identical in appearance, and contents containing placebo or lyophilised venom were dispensed. Early unblinding meant that 12 of 35 VIT‐treated participants were unblinded at the time of the sting challenge; however, outcomes were similar in this group to the other 23 who had blinded sting challenges.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	The outcome assessors were blinded.