Discontinuing venom immunotherapy: Outcome after five years

David B.K. Golden, Kathleen A. Kwiterovich, Anne Kagey-Sobotka, Martin D. Valentine, Lawrence M. Lichtenstein

Research output: Contribution to journalArticlepeer-review

149 Scopus citations


Background: The clinical and immunologic consequences of discontinuing venom immunotherapy are not well-defined. To determine which patients can safely stop treatment, we accepted all volunteers who had completed at least 5 years of maintenance venom immunotherapy regardless of the severity of the historical sting reaction, the persistence of venom skin test sensitivity, or any other variable. Methods: Sting challenge was performed every 1 to 2 years after therapy was stopped; and venom-specific skin tests were performed, and IgE antibody levels were measured. Results: Systemic symptoms occurred after challenge in eight of 270 stings (3%), in seven of 74 patients (10%); only two reactions were clinically significant. Venom skin test results became negative in 28% after 5 years of venom immunotherapy (at the time of discontinuation) and were negative in 56% to 67% of patients after 2 to 4 years without venom immunotherapy. Them was a parallel decrease in the venom- specific IgE antibody levels. Challenge stings did not prevent the progressive decline in sensitivity, nor did they increase the risk of sting reaction even after two sequential stings 1 month apart. Conclusions: Venom immunotherapy can be safely discontinued after 5 years of maintenance therapy in virtually all patients, with the possible exception of those in whom the level of venom sensitivity has not declined during therapy. Venom sensitivity decreases with time even after venom therapy is stopped. Insect stings do not cause re-sensitization, and there was no increased risk from sequential stings. There appears to be a late-onset, non-IgG-mediated mechanism for long-term suppression of allergic sensitivity by prolonged high-dose venom immunotherapy.

Original languageEnglish (US)
Pages (from-to)579-587
Number of pages9
JournalJournal of Allergy and Clinical Immunology
Issue number2
StatePublished - 1996
Externally publishedYes


  • Hymenoptera
  • anaphylaxis
  • immunotherapy
  • insect sting
  • venom

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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