How do you determine which patients to continue VIT beyond 5 years?

For those without ongoing risk factors, 5 years of maintenance VIT provides effective long-term protection, and treatment can generally be discontinued after shared decision-making with the patient. However, extended or indefinite VIT is recommended for patients with a history of, or ongoing, factor...

This is clearly described in the recommendations with supporting evidence and discussion in the Stinging Insect Hypersensitivity Practice Parameter Update 2016 (Golden et al., PMID 28007086). The clinical approach to this decision is further discussed in a recent review article (Golden, PMID 3887886...