Clonal mast cell disorders in patients with systemic reactions to Hymenoptera stings and increased serum tryptase levels - 15/08/11
, Beatrice Caruso, MD d, Sabrina Colarossi, BS e, i, Daniela Dal Fior, MD f, Luca Castellani, MD g, Chiara Bonetto, MSc h, Francesco Frattini, MD b, Annarita Dama, MD a, Giovanni Martinelli, MD e, i, Marco Chilosi, MD f, Gianenrico Senna, MD a, Giovanni Pizzolo, MD b, Roberta Zanotti, MD b, i
Reprint requests: Giovanni Passalacqua, MD, Allergy and Respiratory Diseases, Department of Internal Medicine, Padiglione Maragliano, L.go R. Benzi 10, 16132 Genoa, Italy.Abstract |
Background |
Anaphylaxis after Hymenoptera stings has been reported in subjects with mastocytosis, but few data exist regarding disease prevalence in populations allergic to these insects.
Objective |
The incidence of clonal mast cell (MC) disorders in subjects with both systemic reactions to Hymenoptera stings and increased serum baseline tryptase (sBT) levels was assessed by using bone marrow (BM) aspirates and biopsy specimens.
Methods |
Subjects with a history of a systemic reaction caused by a Hymenoptera sting underwent the standard diagnostic work-up for Hymenoptera allergy, and sBT levels were measured. Subjects with an increased sBT level had BM evaluation that included histology/cytology, flow cytometry, and detection of KIT mutations.
Results |
Forty-four (11.6%) of 379 subjects with systemic reactions had increased sBT levels (>11.4 ng/mL), and 31 (70.5%) of these had a history of anaphylaxis. Thirty-four subjects with increased sBT levels underwent a BM analysis. Histology detected diagnostic or subdiagnostic MC infiltrates in 22 (65%) of 34 patients. Abnormal MCs were identified by means of flow cytometry and cytology in 26 (78.8%) of 33 and 20 (58.8%) of 34 subjects, respectively. A KIT mutation was detected in 17 (54.8%) of 31 subjects. The diagnosis was indolent systemic mastocytosis in 21 (61.7%) of 34 subjects and monoclonal MC activation syndrome in 9 (26.5%) of 34 subjects. All subjects with anaphylaxis had one of those 2 disorders.
Conclusion |
The concomitant presence of systemic reactions (especially anaphylaxis) after Hymenoptera stings and increased sBT levels strongly suggests that a BM examination is indicated for the diagnosis of clonal MC disease.
Le texte complet de cet article est disponible en PDF.Key words : Hymenoptera venom allergy, anaphylaxis, serum tryptase, mastocytosis, bone marrow
Abbreviations used : BM, HVA, ISM, MC, MMAS, sBT, SM
Plan
| Supported by European LeukemiaNet, AIL (Associazione Italiana contro le Leucemie-linfomi e mieloma) Verona Onlus, AIRC (Associazione Italiana per la Ricerca sul Cancro), and Fondazione Del Monte di Bologna e Ravenna. |
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| Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest. |
Vol 123 - N° 3
P. 680-686 - mars 2009 Retour au numéro
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