For most people, hymenoptera stings produce only a transient and bothersome local inflammatory reaction characterised by pain, redness and swelling. Alternatively, for those who are allergic to components of the venom, a re-sting may cause life-threatening, even fatal, reactions. In such patients correct diagnosis is an absolute prerequisite for effective management, i.e. specific venom immunotherapy (VIT) and generally consists of appropriate skin testing and quantification of venom-specific IgE-antibodies (sIgE). In spite the high efficiency of properly administered VIT, the molecular and cellular mechanisms of the desensitisation process are incompletely understood and remain subject of intense research. Besides the general principles and management of hymenoptera venom allergy, this review will focus on the current knowledge on the underlying tolerogenic mechanisms of VIT.