***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Insect hypersensitivity is currently treated by immunization using whole-body extracts . We compared this regimen with immunotherapy using insect venoms or placebo in groups of 20 patients matched for history and sensitivity , as judged by venom skin test , histamine release and IgE antibody to venom . After six to 10 weeks of immunization , systemic reactions to stings occurred in seven of 12 , seven of 11 , and one of 18 patients treated with placebo , whole-body extract , and venom , respectively . Placebo and whole-body extract gave similar results and were significantly less effective than venom immunotherapy ( P less than 0.01 ) . The 14 patients with failure of treatment with whole-body extract and placebo were subsequently provided with venom immunotherapy ; one reacted to a subsequent sting . We conclude that venom immunotherapy is clinical ly superior to therapy on whole-body extract or placebo 24 patients with honey bee sting allergy were treated with either honey bee venom ( HBV ) or monomethoxy polyethylene glycol-coupled HBV ( PEG-HBV ) in a double blind trial . Both treatments induced a strong increase in HBV-specific IgG antibodies in most patients . Immunotherapy with PEG-HBV was much better tolerated than that with HBV . Conversely , patients on HBV did considerably better during a sting challenge with a living honey bee . Only 4 developed a large local and one a mild systemic reaction compared to 7 large local and 3 moderate to severe systemic reactions in the PEG-HBV-group . A higher maintenance dose of PEG-HBV may still be well tolerated but prove more effective at reexposure Venom immunotherapy ( IT ) is a very effective method for the treatment of Hymenoptera venom allergy . We compared safety , efficacy , and modulation of specific immunologic parameters in 70 patients sensitized to Apis mellifera , treated for > or = 5 years with st and ardized quality ( SQ ) aqueous IT , either with a rush ( n = 20 ) or with a cluster ( n = 20 )  induction protocol  , or with an SQ depot extract and a cluster induction protocol ( n = 30 ) . We made an open , noncontrolled study . Side effects were monitored and the effects of field stings during the maintenance phase of the treatment and after its interruption were recorded . Skin reactivity to Apis was measured by end point dilution and specific serum immunoglobulin E ( IgE ) were measured by a solid-phase-based assay . The depot IT was better tolerated than aqueous IT with rush induction . This was caused by mainly the lower frequency in the induction phase of systemic side effects ( 3.4 % versus 36.8 % [ p < 0.0041 ] on a " per patient " and 0.1 % versus 0.9 % [ p = 0.0092 ] on a " per dose " basis , respectively ) . The cluster protocol with the aqueous extract tended to be better tolerated that the rush protocol . About one-half of patients from each group were re-stung during the study and all suffered only minor discomfort . Reduction of skin reactivity and of serum-specific IgE was significant in the three groups ( p < 0.02 in all cases ) . SQ Depot IT to Apis venom allergy administered with a cluster protocol induces less side effects and is equally effective then IT with SQ aqueous extract administered with a rush protocol The incidence , time course and nature of systemic reactions to injections of bee and wasp venom during immunotherapy have been estimated in an open , prospect i ve , single centre study . One hundred and nine survivors of moderate to severe systemic reactions to stings from hymenoptera , received courses of bee or wasp venom by monthly subcutaneous injection for up to 3 years . Systemic reactions were recorded after 7.5 % of 946 weekly venom injections during the initial phase of treatment , and after 2.1 % of 1789 monthly maintenance injections . In both phases of treatment , reactions were more frequent after bee ( 17 % of initial phase , 7.8 % of maintenance treatment ) than after wasp ( 3 % of initial phase , 0.3 % of maintenance treatment ) venom injections . The percentage of patients experiencing at least one reaction was also higher for bee ( 46 % ) than for wasp ( 14 % ) sensitive patients . Over 80 % of reactions began within 30 min of injection , over 90 % within 1 h and only two ( 2 % ) , between 1 and 2 h , the remaining six ( 5.5 % ) starting more than 2 h after injection . Only 0.47 % of venom injections produced a systemic reaction which was severe enough to require adrenaline treatment . The female patients experienced more reactions ( 21 % of the wasp , 60 % of the bee , sensitive ) than the males ( 5.5 % wasp , 20 % bee ) . Age and atopy did not appear to be significant risk factors for systemic reactions . We conclude that wasp and bee venom immunotherapy in a conventional dosage regimen was generally well tolerated . No safety advantage was apparent in keeping the patients under observation for more than 1 h after injections . Reactions are more likely to occur during the initial phase of treatment , in women and after bee , rather than wasp , venom injections Background : The safety profile of venom immunotherapy is a relevant issue . We evaluated the frequency of severe adverse events ( SAE ) , associated risk factors , retrospective comparison of pretreatment protocol s including solely H1 receptor blockers and a combination of H1 and H2 receptor blockers during rush Hymenoptera venom immunotherapy . Methods : The study group comprised 118 patients . The treatment was initiated according to a 5-day rush protocol with the use of st and ardized venom allergens of either wasp or honeybee . Results : During the rush induction , side effects occurred in 18 patients ( 15.2 % ) , whereas SAE were present in 7 patients ( 5.9 % ) . Twelve out of 18 ( 66.6 % ) developed anaphylactic reactions on the fourth day of the rush protocol , with the majority of cases at a dose of 40 or 60 µg of the venom extract ( p = 0.001 ) . The frequency of SAE was also significantly higher on the fourth day than thereafter ( p = 0.0001 ) as well as in patients allergic to bee venom ( p = 0.049 ) . All systemic side effects were more frequent in women ( p = 0.0065 ) . However , this relation was not true when SAE were consider ( p = 0.11 ) . A higher percentage of SAE was observed in the subjects pretreated with both H1 and H2 receptor antagonists than in those pretreated with H1 blocker only ( 8.8 vs. 4.1 % ) ; however , the difference was not significant . Conclusions : Considerable severity of allergic adverse events requires particular attention to patients allergic to bee venom and during rush phase , especially when rapidly increasing doses are administered . Pretreatment with H2 blockers is debatable and warrants further investigation This prospect i ve study over 3 years investigated the safety , immunogenicity , and effectiveness of immunotherapy ( IT ) with aluminum hydroxide adsorbed insect venom extracts ( Alutard SQ , ALK Laboratories ) m patients with previous , severe , systemic , IgE‐mediated , anaphylactic reactions to Hymenoptera stings . Seventeen patients were treated with honeybee venom ( BV ) , 13 with yellow‐jacket venom ( YJV ) , and 5 with both .  No severe reactions to IT were noted . Only 3 BV‐allergic patients experienced mild systemic reactions of grade s I or II ( 1 per 139 injections ) during the increase phase BACKGROUND Venom immunotherapy rapidly reduces the risk of a  systemic sting reaction in adults from 30 % to 70 % to less than 2 % . When venom immunotherapy is stopped after 5 years or longer , the risk of a systemic sting reaction is 5 % to 15 % during the first few years after stopping treatment . It is uncertain whether systemic sting reactions will occur more than 5 years after discontinuing venom immunotherapy and whether treatment can be safely stopped in some patients after less than 5 years . OBJECTIVE The purpose of this study is to estimate the risk of systemic reaction to a sting 10 years after discontinuing treatment and the relative risk after 3 years of treatment compared with that after 5 years or more of treatment . METHODS Among all patients who had venom immunotherapy at our center , we identified 395 patients who stopped treatment : some had dropped out of therapy early ( 6 - 24 months ) , some stopped after 3 to 4 years , and most completed 5 years or more of venom immunotherapy  and were advised to stop by the allergist ( many as part of our reported studies of discontinuing venom immunotherapy ) . RESULTS Contact was made with 194 patients , including telephone interviews for sting history and requests to visit the office for skin testing and blood sampling . Of these patients , 74 had been included in our original study of patients who had 5 years or more of venom immunotherapy and had sting challenges after 1 to 5 years off venom immunotherapy  , as previously reported . Of the 74 in that original study , 61 were reached for this survey , and 30 reported recent stings , with 5 systemic sting reactions . Another 133 patients who had stopped venom immunotherapy  were reached : 82 had 5 or more years of venom immunotherapy , 20 had 3 to 4 years of venom immunotherapy , and 31 had less than 2 years of venom immunotherapy . Of 51 patients stung from this group , 27 had 5 or more years of venom immunotherapy ( no systemic sting reactions ) , and 24 had less than 5 years of venom immunotherapy ( 3 systemic sting reactions ) . We have now observed a total of 113 patients who had 5 or more years of venom immunotherapy and were stung after stopping . Sixteen ( 14 % ) had systemic sting reactions ; most were mild , but 4 were severe . Systemic sting reactions occurred in 12 ( 10.7 % ) of 112 patients stung in the first 4 years off venom immunotherapy and 5 ( 10 % ) of 50 stung more than 5 years off venom immunotherapy . In 4 of 8 patients with current systemic sting reactions , the skin test response was negative , although the venom-IgE response was positive at the previous encounter . All systemic sting reactions were similar in pattern and severity to prevenom immunotherapy reactions in the same patient . CONCLUSIONS We conclude that the risk of systemic sting reactions when venom immunotherapy is stopped after 5 years or longer remains in the reported range of 5 % to 15 % in the 5 to 10 years after stopping venom immunotherapy . This risk of systemic sting reactions does not seem to decrease over time , unlike the progressive decline in immunologic markers ( skin test and venom-IgE responses ) . To prospect ively assess the risk of recurrent systemic sting reactions , there is a need for sting challenge studies of patients who have been off venom immunotherapy for 5 to 10 years and patients who have stopped venom immunotherapy after just 3 to 4 years treatment Venom immunotherapy ( VIT ) with aqueous extracts is considered a life-saving treatment in insect allergy , but systemic side effects are quite common , especially in patients sensitized to Apis mellifera venom . Only a few studies are available regarding depot VIT administered according to the st and ard weekly schedule , while no data are available for cluster VIT with depot preparations . This study was design ed to compare the tolerance of aqueous cluster or rush VIT versus cluster depot VIT in patients sensitized to Apis mellifera . Fifty-five patients with a history of systemic reaction ( grade II to IV according to Müller ) after an Apis mellifera sting were divided at r and om into 3 groups . Forty patients were treated with aqueous VIT  ( 20 according to a cluster schedule and 20 according to a rush schedule ) and 15 with Depot VIT according to a cluster schedule . All local and systemic side effects were recorded . Four patients belonging to the aqueous-cluster , 4 belonging to the aqueous-rush , and 1 belonging to the depot-cluster schedule had large local reactions after VIT ( p < 0.009 ) . Systemic side effects were recorded in 1 , 7 and 0 patients ( p < 0.003 ) respectively . No statistically significant difference was found between the two cluster regimens in the frequency of side effects .  Depot VIT administered according to a cluster schedule was well tolerated , and its tolerance is better than aqueous-rush VIT for Apis mellifera BACKGROUND Hymenoptera venom hypersensitivity is an epidemiologically important problem . The only effective treatment in the management of venom-allergic patients with a history of generalized reactions to insect sting is specific immunotherapy . OBJECTIVE To demonstrate safety and effectiveness of a modified ultrarush desensitization protocol in venom-allergic patients . METHODS Fifty-seven patients with Hymenoptera venom allergy underwent a specific 1-day ultrarush desensitization by the subcutaneous route , reaching the cumulative dose of 101.1 microg in 2.5 hours . The maintenance dose ( 100 microg ) was administered after 15 days and thereafter once a month . Patients were followed up for a year . Antihistamines were withheld for 15 days before and during desensitization to not underestimate the incidence of adverse effects . RESULTS All patients 
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This confirms that during VIT  systemic reactions are significantly more frequent with honeybee venom compared with vespid venom , while there are no significant overall differences in systemic reactions between aqueous and depot extracts