Stinging insect allergy & venom immunotherapy

Stratifies the sting reaction (large local vs cutaneous-only vs systemic), routes VIT by severity and age, and applies the baseline-tryptase/HαT and lifelong-VIT rules. Links the Mueller-grade and tryptase 20%+2 calculators.

Evidence tier: Guideline-derived.

Decision points

  • Classify the sting reaction
  • Cutaneous-only systemic, patient age?

Do-not-miss pitfalls

  • Do not offer VIT for large local reactions or for skin-only systemic reactions in children (low risk).
  • Do not test in the 3-6 week refractory window after a sting, and do not stop at a single negative test if the history is convincing.
  • Do not interpret a positive venom test without a clinical reaction as proof of allergy.
  • Do not omit a baseline tryptase / HαT and mastocytosis consideration in severe venom anaphylaxis.
  • Do not stop VIT at 3-5 years in mastocytosis/elevated-tryptase patients, they need lifelong therapy.

Evidence & citations

  1. Golden DBK, Demain J, Freeman T, et al. Stinging insect hypersensitivity: A practice parameter update 2016. Ann Allergy Asthma Immunol. 2017;118(1):28-54. PMID 28007086
  2. Sturm GJ, Varga EM, Roberts G, et al. EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy. Allergy. 2018;73(4):744-764. PMID 28748641

Clinician decision support. Verify against the cited source. Not a substitute for clinical judgment. 100% on-device; no patient data is stored or transmitted.