Based on the knowledge of the living conditions and habitat of social Aculeatae a series of recommendations have been formulated which can potentially greatly minimize the risk of field re-
sting. After a systemic
sting reaction, patients should be referred to an
allergy specialist for evaluation of their
allergy, and if necessary venom immunotherapy (VIT). An emergency medical kit should be supplied, its use clearly demonstrated and repeatedly practised until perfected. This should be done under the supervision of a doctor or a trained nurse.
Epinephrine by
intramuscular injection is regarded as the treatment of choice for acute
anaphylaxis. H1-antihistamines alone or in combination with
corticosteroids may be effective in mild to moderate reactions confined to the skin and may support the value of treatment with
epinephrine in full-blown
anaphylaxis. Up to 75% of the patients with a history of systemic anaphylactic
sting reaction develop systemic symptoms once again when re-stung. Venom immunotherapy is a highly effective treatment for individuals with a history of systemic reaction and who have specific
IgE to
venom allergens. The efficacy of VIT in yellow jacket
venom allergic patients has been demonstrated also by assessing health-related quality of life. If both skin tests and serum
venom specific
IgE turn negative, VIT may be stopped after 3 years. After VIT lasting 3-5 years, most patients with mild to moderate anaphylactic symptoms remain protected following discontinuation of VIT even with positive skin tests. Longer term or lifelong treatment should be considered in high-risk patients. Because of the small but relevant risk of re-
sting reactions, in these patients, emergency kits, including
epinephrine auto-injectors, should be discussed with every patient when stopping VIT.