The absolute indication of venom immunotherapy is which statement?

• A. The same in every way for kids and adults.
• B. When there is an apiary in the local neighbourhood.
• C. Proved sensitization after previous insect bite causing systemic reactions.
• D. Any form of anaphylaxis.

Answer: (C)

The key idea is that venom immunotherapy is indicated as an absolute need when there is proven sensitization to the venom plus a history of a systemic reaction to a previous sting. In practice, this means the patient has objective evidence of venom-specific sensitization (positive skin test or specific IgE) and has experienced a systemic reaction to a Hymenoptera sting in the past. This combination identifies individuals at high risk for life-threatening reactions on future stings and who will benefit most from desensitization.

Why this option fits best: it directly pairs immunologic sensitization with an actual systemic sting reaction, which is exactly the situation where venom immunotherapy has proven benefit and is considered an absolute indication.

Why other scenarios aren’t absolute indications: being in the vicinity of beehives or having any form of anaphylaxis by itself does not establish a confirmed venom allergy with documented sensitization and prior systemic reaction. Venom immunotherapy is specifically for venom allergy, and the strongest criterion is prior systemic reaction with proven venom sensitization, not just exposure risk or non–venom-related anaphylaxis.