Venom Immunotherapy (VIT) Frequently Asked Questions (FAQ)
This document has been developed by ASCIA, the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand. ASCIA information is based on published literature and expert review, is not influenced by commercial organisations and is not intended to replace medical advice.
This information should be read and understood before signing the ASCIA Venom Immunotherapy Consent Form, prior to commencing venom immunotherapy (VIT).
This FAQ is for venom immunotherapy and there is a separate FAQ for allergen immunotherapy to aeroallergens such as pollen and dust mite.
Q 1. What is venom immunotherapy?
Venom immunotherapy (also known as VIT or venom desensitisation) changes the way the immune system reacts to insect venoms such as Honey Bee, Paper Wasp (polistes), Yellow Jacket (vespula, European Wasp), Jack Jumper Ant and Fire Ant, by changing the body’s allergy response.
- Involves the regular administration of injected (subcutaneous) gradually increasing doses of commercially available venom allergen preparations. Sublingual immunotherapy is not available for insect venoms.
- Is not a quick fix form of treatment, as it usually requires a commitment of five years to result in tolerance to venoms that is mostly maintained for years. Symptoms may return after this time.
- Only works if high and standardised doses are used, and is therefore different to homeopathy. Homeopathy claims to cure a variety of medical conditions using extremely weak extracts, there is no scientific evidence to support this.
Q 2. What conditions can venom immunotherapy help?
- Is recommended and highly protective for the treatment of potentially life-threatening allergic reactions to venom from stinging insects.
- Is sometimes recommended for the treatment of generalised reactions, such as an all over rash.
- Is not recommended for the treatment of large local swellings.
Q 3. What should I expect?
- Venom immunotherapy for insect allergy is given by regular injections for five years in most cases, sometimes longer.
- Allergy medicines can still be used to help manage symptoms while undergoing venom immunotherapy.
Q 4. What allergen extracts are available in Australia and New Zealand?
- Venom immunotherapy products available in Australia and New Zealand include:
- Honey Bee.
- Paper Wasp, Yellow Jacket (European Wasp).
- Jack Jumper Ant.
- Allergen immunotherapy products are normally standardised and labelled by the concentration of protein and/or allergen, expressed as one or more of weight/volume or in-house measures of allergenic reactivity.
- The quality of the allergen is critical for both diagnosis and treatment, therefore only commercially available allergens should be administered.
- Different brands and different preparations (such as aqueous or alum adsorbed) are NOT interchangeable for treatment.
- Choice of product after informed discussion between the doctor and person being treated (or their carer) about the most appropriate product for them.
- A current list of allergen immunotherapy suppliers is available at allergy.org.au/members/allergen-immunotherapy-information
Q 5. How often are venom immunotherapy injections given?
- Injections start with a very low dose. A small needle is used which may be uncomfortable, but not very painful.
- Doses are gradually increased on a regular (usually weekly) basis, until an effective maintenance dose is reached. It may take two to six months to reach an effective maintenance dose.
- Once the maintenance dose is reached, injections are usually administered monthly in a medical facility under supervision. Patients should stay at the medical facility for observation for 45-60 minutes after a venom immunotherapy injection has been given.
- In some cases, after the treatment has been maintained for two or more years, the time interval between doses may be extended. This can be discussed with the supervising specialist.
- If the injections are given in a local medical practice, periodic review with the responsible Allergy specialist should continue.
Q 6. Are there any potential reactions to venom immunotherapy injections?
Localised swelling at the site of the injection can be treated with non-sedating oral antihistamines or ice packs and if painful, paracetamol.
More serious reactions (such as anaphylaxis) are uncommon. Predicting who might have serious reactions is difficult. Patients are normally advised to:
- Remain in their doctor's surgery for at least 45-60 minutes after injection.
- Avoid exercising for at least three hours after treatment.
- Avoid some heart and blood pressure medications including beta blockers such as metoprolol or propranolol. It is important to talk to your doctor if starting any new medications while on venom immunotherapy.
- Taking a non-sedating oral antihistamine before the injection may reduce the risk of side effects and may be recommended by your doctor.
It is important to inform your doctor about any reactions you may have experienced after your last injection and any new medications you are taking (such as eye drops, new heart/blood pressure tablets), or if you become pregnant.
Patients who are pregnant (or planning to become pregnant) are not routinely commenced on venom immunotherapy until after they have given birth. If the patient is on maintenance doses of venom immunotherapy and then becomes pregnant, the injections can be continued (unless the patient wishes to stop), the supervising specialist must be contacted to discuss relevant safety issues.
Q 7. Is there anything you can do to reduce the side effects from venom immunotherapy?
Simple precautions may reduce the risk:
- Asthma should be stable before treatment starts. If an asthma flare occurs during treatment, the injection should be deferred until it is back under control.
- You must tell your doctor if you develop itchy eyes, itchy nose, itchy throat or chest, increased wheezing or if you feel light-headed or faint after an injection. You should never put up with these symptoms.
- Double check with your specialist and GP if you are taking any heart or blood pressure medicines or glaucoma eye drops, as some can increase the risk of side effects.
- If you are on venom immunotherapy and plan to start a new heart or blood pressure medicine or glaucoma eye drop, tell your GP.
- If you have ongoing side effects, let your GP and specialist know about it as soon as possible. A few minor changes to treatment may allow you to tolerate it better.
- If you are sick or have a fever, it may be better to delay a dose. Discuss this with your GP or specialist.
Q 8. Are there cases when allergen immunotherapy should not be given?
- Pregnancy: It is normally recommended not to start treatment if you are already pregnant or planning pregnancy. If you become pregnant while on treatment discuss this with your allergy specialist.
- Breast-feeding: Treatment can be started or continued whilst breastfeeding.
- Age: Venom immunotherapy is not normally started in children less than five years of age.
- Arm lymphoedema (swelling) after breast cancer surgery. If a lymph node dissection has been done on one arm, then do not give injections on that side. If injections can’t be given in the arm, the injections can be given elsewhere, such as the leg or under the skin of the stomach.
Q 9. What are the costs of allergen immunotherapy?
- Allergen extracts for insect venoms are subsidised by the Pharmaceutical Benefits Scheme (PBS) in Australia and by Pharmac in New Zealand.
- Patients with private health insurance may get a rebate, but usually only for TGA registered products.
© ASCIA 2023
Content updated June 2023
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