Clonal mast cell disorders in patients with systemic reactions to Hymenoptera stings and increased serum tryptase levels
Open accessAbstract
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.
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In patients with systemic mastocytosis and MCAS, IgE-dependent allergy such as insect venom allergy is frequently documented.
“in patients with systemic mastocytosis (SM) and MCAS, an IgE-dependent allergy (e.g., against insect venom) is frequently documented.”
From Proposed Diagnostic Algorithm for Patients with Suspected Mast Cell Activation Syndrome (2019) · cites this paper as [23]
The Final diagnosis section reports Hymenoptera venom allergy in patients diagnosed with indolent systemic mastocytosis or monoclonal mast cell activation syndrome; allergy tests were negative in 4 of the 34 evaluated subjects. But the Methods (Subjects) section shows that participants were selected because they had already had systemic sting reactions and elevated tryptase, so these findings do not establish that IgE-dependent allergy is frequent among patients with SM or MCAS generally. The paper does not assess the frequency of other IgE-dependent allergies in those populations. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPatients with combined primary and secondary MCAS are at high risk of recurrent life-threatening anaphylaxis.
“These patients suffer from a combination of primary and secondary MCAS, and, as a result, they are at high risk to develop recurrent life-threatening anaphylaxis (21-23).”
From Proposed Diagnostic Algorithm for Patients with Suspected Mast Cell Activation Syndrome (2019) · cites this paper as [23]
The introductory discussion (page not available) says that patients with Hymenoptera venom allergy and systemic mastocytosis have an increased risk of severe systemic reactions. The “Systemic reactions to” section also says early diagnosis could help prevent further severe reactions. The paper does not establish that patients with combined primary and secondary MCAS generally face a high risk of recurrent life-threatening anaphylaxis; its findings concern patients with sting reactions and increased baseline tryptase. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPatients with mixed MCAS are at high risk for developing recurrent life-threatening anaphylaxis, particularly after Hymenoptera stings, and possibly after exposure to food, drugs, and other allergens.
“thus, they are at high risk for developing recurrent life-threatening anaphylaxis, particularly after Hymenoptera stings, 23,100-102 but they might also be after exposure to food, drugs, and other allergens. 103-105”
From Selecting the Right Criteria and Proper Classification to Diagnose Mast Cell Activation Syndromes: A Critical Review (2021) · cites this paper as [100]
The Final diagnosis section reports that six of nine patients with monoclonal mast cell activation syndrome had a history of anaphylaxis caused by Hymenoptera venom, supporting the sting-related portion of the cited claim. The paper addresses monoclonal, not mixed, MCAS and does not establish a high risk of recurrent life-threatening anaphylaxis in patients with mixed MCAS. The food, drug, and other-allergen clause has separate citations in the citing sentence. (LLM, conf=0.82)
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Bone Involvement and Osteoporosis in Mastocytosis
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- Authors
- Bonadonna, P., Perbellini, O., Passalacqua, G., Caruso, B., Colarossi, S., Dal Fior, D., Castellani, L., Bonetto, C., Frattini, F., Dama, A., Martinelli, G., Chilosi, M., Senna, G., Pizzolo, G., & Zanotti, R.
- Affiliations
- Azienda Ospedaliera Universitaria Integrata Verona (IT)
- University of Verona (IT)
- University of Genoa (IT)
- University of Bologna (IT)
- Corresponding author
- Passalacqua, Giovanni
- ORCID
- Venue
- Journal of Allergy and Clinical Immunology
- Publisher
- Elsevier BV
- Published
- 2009-03
- Volume
- 123
- Issue
- 3
- Pages
- 680-686
- ISSN
- 0091-6749 (ISSN-L)
- OpenAlex
- W2095523733
- Cited by
- 392
- References
- 36
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 14 · 2023: 16 · 2022: 16 · 2021: 21 · 2020: 18 · 2019: 36 · 2018: 17 · 2017: 19 · 2016: 23 · 2015: 30 · 2014: 39 · 2013: 31 · 2012: 16
- FWCI
- 13.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Allergy and Clinical Immunology (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Mast cells and histamine
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Health Sciences › Medicine › Rheumatology › Eosinophilic Disorders and Syndromes
- Keywords
- clonal mast cell disorders, systemic anaphylaxis, serum tryptase, indolent systemic mastocytosis, KIT mutations, mastocytosis diagnosis
- MeSH terms
- Adolescent, Adult, Aged, Anaphylaxis, Animals, Bone Marrow, Child, Clone Cells, Female, Humans, Hymenoptera, Insect Bites and Stings, Male, Mast Cells, Mastocytosis, Middle Aged, Skin Tests, Incidence, Point Mutation, Proto-Oncogene Proteins c-kit, Tryptases, Young Adult
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