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Background   Hymenoptera  venom immunotherapy (VIT) is a clinically effective treatment. However, little is known about its long-term clinical efficacy and biological effects. Several mechanisms have been proposed to account for VIT efficacy, including reduction of specific IgE and induction of allergen-specific IgG 4 , but the overall picture remains elusive. We investigated  Vespula  VIT clinical efficacy up to 8 years after discontinuation and the kinetics of  Vespula -specific IgE and IgG 4 . Out of 686 consecutive patients we retrospectively selected and analysed a series of 23 patients with  Vespula  allergy that underwent a 5-year IT course, followed by a prolonged follow-up.    Methods  Clinical efficacy of VIT was assessed as number and severity of reactions to  Vespula  re-stinging events. The presence of  Vespula -specific IgE and IgG 4  was also monitored over time.    Results  During the VIT treatment, patients were protected, reporting no reactions or mild reactions in occasion of re-stinging events. This protection was entirely maintained during the follow-up, up to 8 years. Skin reactivity (reflecting mast cell-bound  Vespula -specific IgE) and circulating  Vespula -specific IgE levels declined substantially during VIT. Notably, this reduction was maintained over time during the follow-up. Moreover, all the patients were analysed for IgG 4 . A robust induction of  Vespula -specific IgG 4  was observed during the VIT course, with a substantial decline during the follow-up.    Conclusions  We conclude that  Vespula  VIT is a clinically effective treatment, which induces long-term protection after discontinuation. The reduction of specific IgE, assessed by skin tests and RAST, closely matches the VIT- induced protection, while the IgG 4  induction seems not to be associated with VIT clinical efficacy in the long term.    Electronic supplementary material  The online version of this article (10.1186/s12948-017-0079-y) contains supplementary material, which is available to authorized users.

A 13-year real-life study on efficacy, safety and biological effects of Vespula venom immunotherapy