Safety and effectiveness of immunotherapy in patients with indolent systemic mastocytosis presenting with Hymenoptera venom anaphylaxis

Allergy Unit, Hospital de Fuenlabrada, Madrid, Spain.
The Journal of allergy and clinical immunology (Impact Factor: 11.48). 02/2008; 121(2):519-26. DOI: 10.1016/j.jaci.2007.11.010
Source: PubMed


Anaphylaxis after Hymenoptera sting has been described in patients with mastocytosis. Venom immunotherapy (VIT) is a safe and effective way to treat patients with Hymenoptera anaphylaxis, but few studies have addressed its usefulness in patients with systemic mastocytosis.
To study the effectiveness and safety of VIT in patients with systemic mastocytosis having anaphylaxis after Hymenoptera sting.
A total of 21 mastocytosis patients-4 women (19%) and 17 men (81%) with a median age of 50 years (range, 29-74 years)-with Hymenoptera sting anaphylaxis who were treated with VIT and followed for a median of 52 months (range, 2-250 months) were studied.
In 18 of 21 patients-16 of them lacking skin involvement-anaphylaxis was the presenting symptom. Six patients (29%) experienced adverse reactions during VIT, 3 during initiation and 3 during maintenance. Twelve patients (57%) were resting while undergoing VIT; 9 (75%) presented local reactions and 3 (25%) systemic reactions, 1 of which required intubation. The Hymenoptera specific IgE decreased from 4.15 kU/L (range, 0.44-100 kU/L) before immunotherapy to 1.2 kU/L (range, 0.34-69.4 kU/L) after 4 years (P < .003).
Venom immunotherapy is effective to treat IgE-mediated Hymenoptera anaphylaxis in patients with mastocytosis. Its use is recommended despite a relatively high risk of adverse reactions during the build-up phase because it provides protection from anaphylaxis in around 3/4 of the patients.

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    • "Of a number of potential risk factors for treatment failure, only one reached statistical significance: severe anaphylaxis following the pre-VIT index sting was indicative of a higher risk of recurrence (P = 0.02) which is in accordance with the results of some previous studies [31,34], but was not supported by others [24,26,27,32,37]. Case series and epidemiological studies have clearly documented that both, the severity of anaphylaxis to the index sting as well as the risk of treatment failure, are related to an increase of the baseline serum tryptase concentration [38-41]. Tryptase determination is nowadays an integrative part of diagnostic assessment in Hymenoptera venom allergic patients, but was not routinely available during the first decade of our study. "
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