A new research review published in the journal Allergy suggests that routine intravenous (IV) cannulation may offer little benefit for most individuals undergoing venom immunotherapy treatment (VIT) while adding costs, delays and potential harms.
The study also found that people living with systemic mastocytosis (SM) – who are known to face a higher risk of severe allergic reactions, including anaphylaxisAnaphylaxis A severe allergic reaction that can turn fatal without treatment. Patients with SM are at a higher risk of developing anaphylaxis. triggered by insect stings – are more likely to experience serious reactions during VIT.
Researchers in Australia analyzed outcomes from 456 patients who began Hymenoptera venom immunotherapy at a single medical center between 2016 and 2025. The treatment, which is used to reduce the risk of severe allergic reactions to insect stings, included therapy targeting honeybee, vespid and jack jumper ant venom.
Across 2,388 treatment visits and 5,520 injections, 54.6% of patients experienced at least one systemic reaction during the dose-escalation phase of treatment. Most reactions were mild to moderate, while 4.4% of patients experienced severe reactions and 8.3% required treatment with adrenaline.
Although only 10 patients in the study had mastocytosisMastocytosis Rare disease caused by the buildup of mast cells. Cutaneous mastocytosis primarily affects the skin and is more common in children, while systemic mastocytosis affects internal organs and is more common in adults., this group appeared to be at substantially higher risk. Severe reactions and adrenaline use were significantly more common in this group than among patients without mastocytosis.
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The researchers examined the value of routine peripheral IV cannula insertion, a precautionary practice historically used during VIT. This places an IV line in a vein in case emergency treatment becomes necessary, such as if a patient’s reaction to VIT necessitates adrenaline.
From 2016 to 2019, when the center routinely performed the procedure, 175 patients underwent 1,344 up-dosing visits, yet none required use of the pre-emptively inserted IV line. Instead, routine cannulation was associated with complications such as vasovagal fainting, anxiety and delays in care. The researchers estimated the practice cost more than AUD $30,000.
After the practice was discontinued, 284 additional patients began VIT. Only one individual, who had mastocytosis, ultimately required IV access.
The researchers concluded that routine IV cannulation can likely be avoided in most specialized venom immunotherapy settings, although selective use may still be appropriate for higher-risk patients, including some individuals with mastocytosis or a history of severe allergic reactions.
“These findings highlight the importance of regularly reviewing safety practices to ensure protocols remain targeted, proportionate and evidence-based while minimising unintended harm,” the authors wrote.
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