Guidelines have been modified on insect sting allergies and VIT. This review examines the development and similarities and differences of these guidelines. In most sectors, the US and European VIT rules are similar and complementary. The EU guidelines are restricted to the VIT recommendations and are based on a published systemic evaluation; the US practise criteria span all diagnostic and insect sting allergy management domains and do not employ GRADE. The overall consensus is that children and adults with systemic skin responses do not need VIT and that β-blockers and angiotensin-converting enzyme inhibitors are associated with a minimum risk during VIT. Details of the VIT dose, scheme, and venom choice are minor variances but there is consensus about the length and the risk factors for recurrence following VIT. In their description of the relationship between mastocytosis and insect sting anaphylaxis and the significance of basal serum tryptase, the American and European guidelines complement each other. 

The new guidelines on the allergy of insect sting from the United States and Europe are varied in extent and are a little different in some fields but complementary in general. Where they overlap, the distinctions in suggestions are relatively few and they are slight. An annotated approach is available for evaluating and treating patients with bug sting reactions.

Reference: https://journals.lww.com/co-allergy/Abstract/2019/10000/Insect_sting_allergy__new_guidelines_from_the.8.aspx