Golden 2009.

Methods	This was a quasi‐randomised, open‐label, controlled, parallel‐group trial.
Participants	This trial was conducted in the USA. The participants were adults aged 21 to 63 years. The total number of participants was 29. The total number of participants in the treatment group was 19. The total number of participants in the control group was 10. No distribution by gender was reported. The species of insect venoms that the participants were allergic to were honeybee (7), yellowjacket (2), polistes wasp (2), and mixed vespid (18). Inclusion criteria of the trial History of a large local reaction to insect sting Wheal > 5 mm and erythema > 10 mm in intradermal test and local induration of ≥ 16 cm in a sting challenge Exclusion criteria of the trial Use of β‐blockers medication Pregnancy or insufficient measures to avoid pregnancy and previous sting anaphylaxis or VIT Uncontrolled asthma or other medical conditions that might affect the risk or outcome of anaphylaxis
Interventions	Treatment: subcutaneous injections of VIT VIT Manufacturer: ALK‐Abelló Duration: 12 weeks Updosing: Used a dose schedule to achieve the maintenance dose in 7 weekly visits Maintenance dose: 100 µg every 4 weeks Control: no treatment
Outcomes	Outcomes of the trial 1. Systemic reaction to insect sting challenge  2. Fatal systemic reaction to insect sting challenge                     3. Large local reactions to insect sting challenge (measured by participants at home using study measuring equipment) 4. Adverse events to immunotherapy
Notes	This study was funded by the National Institutes of Health and ALK‐Abelló (VIT manufacturer).
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Randomisation was done based on sequence of enrolment, probably using alternation ‐ therefore, this was a quasi‐randomised study.
Allocation concealment (selection bias)	High risk	This was inadequate.
Incomplete outcome data (attrition bias) All outcomes	Low risk	There were no losses to follow up during the 12‐week period.
Selective reporting (reporting bias)	Low risk	The specified outcomes in the methodology were reported in the results section.
Other bias	Low risk	No other sources of bias were detected or suspected.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and personnel were not blinded.
Blinding of outcome assessment (detection bias) All outcomes	High risk	Outcome assessors were not blinded.