A hypersensitivity to the venom of hymenoptera insects deserves special attention because of the life-threatening symptoms that can occur among effected persons upon being stung by one of them.

In Europe potential fate allergic reactions to venom occur more frequently among people who have been stung by honeybees and wasps, than those stung by hornets or bumblebees. 

A hypersensitivity to hymenoptera insects may develop as the result of a reaction produced by the immune system (an IgE-dependent or IgE-dependent allergy). It can also be caused by mechanisms that are unrelated to the immune system. In the latter case it takes the form of none-allergic hypersensitivity (also called intolerance).

Upon being stung a person may experience a typical or unusually severe local reaction. An anaphylactic and atypical or toxic reaction may also occur.
Unusually severe local reactions occur in 2.4% - 26.4% of cases. Anaphylactic reactions are rarer – they occur in 0.3% - 7.5% of cases in general and in 14.0% - 43.0% of cases among beekeepers ( 1,2 ).
The first step to diagnosing an allergy to insect venom is an interview with the potentially effected party in order to learn his/her medical history. It is also necessary to conduct skin and blood tests in order to identify the (insect-specific) venom causing the allergic reaction, degree to which a given person is allergic and level of allergen specific IgE antibodies as well as tryptase – the latter to eliminate the possibility of mastocytosis (3-5).

Therapy is carried out on different levels at various stages: a) directly after the sting b) after anaphylaxis is under control c) treatment of what causes the hypersensitivity – allergen immunotherapy for the venom of hymenoptera insects.
The only effective method of hymenoptera insect allergy treatment is allergen immunotherapy ( venom immunotherapy – VIT).

All those who have been diagnosed with IgE-dependent allergy qualify for this form of treatment (which last from 3-5 years to take full effect - depending on the individual case). People diagnosed with mastocytosis should undergo VIT for the rest of their lives.
VIT is recommended to all those who experience an allergic reaction  that effects their respiratory or cardiovascular systems (belonging to III and IV class according to Mueller) and:

• test positive during skin test and/or specific IgE antybodies as well as being at high risk of a nettle rash.
• experience a significant decrease in the quality of their lives after being stung while also testing positive during skin test and/or test for specific IgE antibodies (4).

Allergen immunotherapy may not be the recommended course of action if a patient is:

• Hesitant to undergo treatment
• Under 5 years of age
• Suffering from cancer or auto-aggression
• Suffering from persistent organ failure
• Pregnant (3,4)

In addition people who take β-blockers or inhibitors of the converting enzyme should replace them with a different type of medication – if they do not, the interaction of the above medication with VIT may cause unpleasant side effects. Such side effects may include excessive local and anaphylactic reactions.

More specifically, among people taking ß-blockers epinephrine may prove ineffective. Inhibitors of the enzyme converting angiotensin, on the other hand,  may, because of the stronger concentration of bradykinin which they cause, can increase the permeability of blood vessels thus increasing the symptoms of circumscribed edema.   

Selection of appropriate vaccine depends on identification of an insect and cross-reactivity between venoms. The timetables for VIT treatment vary, first and foremost, as to the minimal time required to achieve the maintenance dose (usually 100 μg of venom). The time required to do this varies from as long as a few weeks or months to as short as a few days or hours.

The variables that have an impact on the effectiveness of allergen immunotherapy are not, as of yet, firmly defined – they are still a hot topic of discussion among members of the medical community.  The latest research shows that immunotherapy prevents  reply of lymph cells Th2 to allergens, and change the reply of the immune system from dominate Th2 type to lymph cells Th1, that create large amounts of interferon-γ, as well as regulatory lymph cells, which are the source of cytokines that prevent an inflammatory reply IL-10 and the transforming growth factor -β (6-9).
The effectiveness of allergen immunotherapy is judged based on negative reading in skin, specific IgE antibodies and (once in a while) provocation tests.
Allergen immunotherapy for insects’ venom is very effective -  it is among the most successful types of immunotherapy.

In case of wasp’s venom it success rate is 95%, in the case of bees – 80-90% (10, 11).
Allergy immunotherapy is carried out at the request of an interested party who suffers from IgE-depended allergy to the venom of hymenoptera insects.

Despite all the merits of VIT treatment there is still a need for developing better way of diagnosing hypersensitivity to  the venom of insects as well as a method to measure the effects of the above mentioned treatment more accurately.