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Cited by 53Mast cells and histamineFood Allergy and Anaphylaxis ResearchVenomous Animal Envenomation and Studies

Hymenoptera venom-induced anaphylaxis and hereditary alpha-tryptasemia

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O’Connell, Michael P., Lyons, Jonathan J.·2020·Current Opinion in Allergy & Clinical Immunology
DOI 10.1097/aci.0000000000000678PMC PMC8162786
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Abstract

Purpose of review: To discuss the association between the common dominantly inherited genetic trait hereditary alpha-tryptasemia (HαT) and hymenoptera venom-induced anaphylaxis (HVA). Recent findings: Elevated BST has been correlated with more severe systemic anaphylaxis in humans in a number of settings – most notably in HVA. Clonal mast cell disease, in particular, systemic mastocytosis, is frequently associated with elevated BST, and is a major risk factor for severe HVA. However, clonal mast cell diseases are believed to be rare, whereas HVA is relatively more common. HαT affects an estimated 3–5% of Western populations and is the common cause for elevated BST in these individuals. An association between HαT and severe HVA, as well as clonal mast cell disease has recently been demonstrated wherein this trait modifies reaction severity in venom allergic individuals. A mechanism underlying this association has been proposed through the identification of naturally occurring heterotetrameric tryptases and characterization of their unique physical attributes. Summary: Here we discuss the long-standing association between elevated BST and HVA severity, how HαT fits into this landscape, and review the clinical and mechanistic evidence that supports HαT as a modifier of HVA.

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  • Various clinical conditions, including dysautonomia with postural orthostatic hypotension, flushing, gastrointestinal hypomotility, joint hypermobility, vibratory urticaria, irritable bowel syndrome, chronic musculoskeletal pain, retained primary dentition, and allergic disorders, were initially reported in patients with hereditary alpha-tryptasemia.

    “Initially, various clinical conditions, including dysautonomia with postural orthostatic hypotension, fl ushing, gastrointestinal hypomotility, joint hypermobility, vibratory urticaria, irritable bowel syndrome, chronic musculoskeletal pain, retained primary dentition, and allergic disorders, were reported in patients with H a T. 120,121,125-127”

    From Selecting the Right Criteria and Proper Classification to Diagnose Mast Cell Activation Syndromes: A Critical Review (2021) · cites this paper as [127]

    The section “Hereditary alpha-tryptasemia (HαT) is a common genetic trait” (page not provided) reports IBS-like symptoms, flushing, retained primary dentition, body pain, joint hypermobility, and hypersensitivity reactions in association with HαT. The mechanisms section also describes vibration-triggered hives in some patients, but the copy does not report dysautonomia with postural orthostatic hypotension or gastrointestinal hypomotility. It distinguishes vibratory urticaria from the vibration-triggered symptoms reported in HαT. (LLM, conf=0.87)

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Authors
O’Connell, M. P., & Lyons, J. J.
Affiliations
National Institutes of Health (US)
Corresponding author
Lyons, Jonathan J.
ORCID
Venue
Current Opinion in Allergy & Clinical Immunology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2020-08-06
Volume
20
Issue
5
Pages
431-437
ISSN
  • 1473-6322 (ISSN-L)
  • 1528-4050
DOI
10.1097/aci.0000000000000678
PMC
PMC8162786
OpenAlex
W3048000325
Cited by
53
References
9
Citations by year
2026: 5 · 2025: 10 · 2024: 9 · 2023: 8 · 2022: 7 · 2021: 13 · 2020: 1
FWCI
0.71
Type
journal article
Language
en
Open access
Locations
  • Current Opinion in Allergy and Clinical Immunology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (Z99 AI999999)
  • National Institute of Allergy and Infectious Diseases (ZIAAI001192)
Topics
  • Life Sciences › Immunology and Microbiology › Immunology › Mast cells and histamine
  • Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Venomous Animal Envenomation and Studies
Keywords
hereditary alpha-tryptasemia, basophils, tryptase, systemic mastocytosis, venom allergy, anaphylaxis severity, genetic modifiers
MeSH terms
Anaphylaxis, Animals, Arthropod Venoms, Humans, Hymenoptera, Insect Bites and Stings, Mast Cells, Severity of Illness Index, Genetic Diseases, Inborn, Mastocytosis, Systemic, Tryptases

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