Clonal mast cell disorders in patients with systemic reactions to Hymenoptera stings and increased serum tryptase levels

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:123

Article

Bonadonna, Patrizia^1,8  Perbellini, Omar^2,8  Passalacqua, Giovanni³  Colarossi, Sabrina^4,8  Dal Fior, Daniela⁵  Castellani, Luca⁶  Bonetto, Chiara⁷  Frattini, Francesco²  Dama, Annarita¹  Martinelli, Giovanni^4,8  Chilosi, Marco⁵  Senna, Gianenrico¹  Pizzolo, Giovanni²  Zanotti, Roberta^2,8 

[1] Verona Gen Hosp, Allergy Unit, Verona, Italy

[2] Univ Verona, Haematol Sect, Dept Clin & Expt Med, I-37100 Verona, Italy

[3] Univ Genoa, DIMI, Genoa, Italy

[4] Univ Bologna, Dept Haematol Oncol L&A Seragnoli, Bologna, Italy

[5] Univ Verona, Dept Pathol, I-37100 Verona, Italy

[6] Santa Maria del Carmine Hosp, Dept Dermatol, Rovereto, Italy

[7] Univ Verona, Dept Med & Publ Hlth, Sect Psychiat & Clin Psychol, I-37100 Verona, Italy

[8] Rete Italiana Mastocitosi, Verona, Italy

关键词: Hymenoptera venom allergy;    anaphylaxis;    serum tryptase;    mastocytosis;    bone marrow;   

DOI  :  10.1016/j.jaci.2008.11.018

来源: Elsevier

【 摘 要 】

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 How 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. (J Allergy Clin Immunol 2009;123:680-6.)

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