“Non-purified” Hymenoptera venom extracts—from protein to preferred product

Hymenoptera venom extracts for allergen-specific immunotherapy (AIT) are marketed with the attributes “purified” or “highly purified” or “non-purified.” However, all manufacturing processes include purification steps and are subject to the same requirements of the European Pharmacopoeia. European and national guidelines confirm that “purified” and “non-purified” Hymenoptera venom AIT (VIT) do not differ in their effectiveness and frequency of systemic adverse events (AE). Differences in preserving natural venom composition appear more relevant. Hymenoptera venom AIT is considered the success model for AIT. Protection rates of close to 100% can be achieved for both bees and wasps. However, with several years of administration of aluminum, depot VIT is also considered a role model for iatrogenic aluminum exposure through long-term subcutaneous immunotherapy (SCIT). Its relevant iatrogenic contribution to the accumulation of aluminum in the body is now widely recognized. Considering patient preferences improves adherence, among others. “Our own” surveys conducted by the author, comparing product characteristics of SCIT preparations, indicate that patients prefer products without aluminum.