Thank you for your inquiry.
As always, the decision as to whether or not to begin any form of allergen immunotherapy in a patient who has other medical problems is one based upon an analysis of the risk/benefit ratio. In your case, in my opinion, the risk/benefit ratio favors the initiation of venom immunotherapy. The reasons for this are:
Anaphylactic events themselves are epileptogenic, and seizures can be a component of anaphylactic events. I think that the greater risk to your patient is a field sting-induced anaphylactic event rather than an event due to immunotherapy where he will be under your observation.
Hymenoptera allergy itself can be fatal, and therefore from that standpoint alone, I believe immunotherapy is justified in your patient.
I know of no consensus statement or evidence-based literature that suggests a seizure disorder is a contraindication to venom immunotherapy.
Thank you again for your inquiry and we hope this response is helpful to you.
Phil Lieberman, M.D.