Document Detail

Mastocytosis and insect venom allergy.
MedLine Citation:
PMID:  20485157     Owner:  NLM     Status:  MEDLINE    
PURPOSE OF REVIEW: To analyse the association of systemic allergic hymenoptera sting reactions with mastocytosis and elevated baseline serum tryptase and to discuss diagnosis and treatment in patients with both diseases. RECENT FINDINGS: In recent large studies on patients with mastocytosis a much higher incidence of severe anaphylaxis following hymenoptera stings than in the normal population was documented. In patients with hymenoptera venom allergy, elevated baseline tryptase is strongly associated with severe anaphylaxis. Fatal sting reactions were reported in patients with mastocytosis, notably after stopping venom immunotherapy. During venom immunotherapy most patients with mastocytosis are protected from further sting reactions. Based on these observations immunotherapy for life is recommended for patients with mastocytosis and venom allergy. The incidence of allergic side-effects is increased in patients with mastocytosis and elevated baseline tryptase, especially in those allergic to Vespula venom. Premedication with antihistamines, or omalizumab in cases with recurrent severe side-effects, can be helpful. SUMMARY: In all patients with anaphylaxis following hymenoptera stings, baseline serum tryptase should be determined. A value above 11.4 microg/l is often due to mastocytosis and indicates a high risk of very severe anaphylaxis following re-stings. Venom immunotherapy is safe and effective in this situation.
Patrizia Bonadonna; Roberta Zanotti; Ulrich Müller
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in allergy and clinical immunology     Volume:  10     ISSN:  1473-6322     ISO Abbreviation:  Curr Opin Allergy Clin Immunol     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-08     Completed Date:  2010-10-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100936359     Medline TA:  Curr Opin Allergy Clin Immunol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  347-53     Citation Subset:  IM    
Allergy Unit, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
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MeSH Terms
Anaphylaxis / etiology*,  immunology,  prevention & control
Anti-Allergic Agents / therapeutic use
Arthropod Venoms / administration & dosage,  adverse effects,  immunology*
Desensitization, Immunologic / methods
Hymenoptera / immunology*
Hypersensitivity, Immediate / complications*,  etiology,  immunology,  therapy
Insect Bites and Stings / immunology
Mastocytosis / complications*,  diagnosis,  immunology,  therapy
Tryptases / blood*
Wasp Venoms / administration & dosage,  adverse effects,  immunology
Reg. No./Substance:
0/Anti-Allergic Agents; 0/Arthropod Venoms; 0/Wasp Venoms; EC

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