Hymenoptera Venom Extracts in Clinical Practice

Venom immunotherapy is the only treatment for the prevention of anaphylaxis and remains the prototypical model for its diagnosis and management. Unlike other causes of anaphylaxis, such as foods and drugs, preventative treatment using venom immunotherapy is highly effective with well-established protocols, and is widely available. Hymenoptera venoms are also unique in that the primary allergens are directly measurable in terms of micrograms, rather than labeled on the basis of potency. As such, venoms were the first truly standardized extracts. However, Hymenoptera venom presents unique challenges in collection, processing, and stabilization of the venom extract product. Historically, there have been minor variations in insect composition in venom extract content. These differences were in part based on variation in insect availability and venom collection and have created minor challenges. However, it is a recognized need that venom extracts contain an optimal and complete repertoire of relevant venoms so as to be assured of appropriate diagnosis and treatment. As such, insect availability and collection, as well as storage, stability, and sterility of venom extracts, have remained critical components to appropriate diagnosis and prevention of venom-induced anaphylaxis. In recent years there has been concerns about adequate supplies of venom for appropriate diagnosis and treatment of venom allergy, but these concerns seem to have stabilized, with the movement to a single venom supplier. This movement to a single supplier may provide its own challenges.