Fatal anaphylaxis after a yellow jacket sting, despite venom immunotherapy, in two patients with mastocytosis

Elberink, Joanne N.G. Oude; Monchy, J. G. R. De; Kors, J. W.; Doormaal, Jasper J. van; Dubois, Anthony

doi:10.1016/s0091-6749(97)70314-2

Cited by 183 publications

(149 citation statements)

References 6 publications

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“…Such symptoms can develop in any category of SM and can represent a serious clinical problem [22, 23, 24, 25, 26, 27, 28]. In those patients who do not show typical skin lesions, these symptoms may be confused with allergies, endocrinologic disorders, or other internal diseases [28].…”

Section: Discussionmentioning

confidence: 99%

“…In any category of mastocytosis, clinical problems may occur from massive release of MC-derived vasoactive mediators [22, 23, 24, 25, 26, 27, 28]. The triggering factors often remain unknown.…”

Section: Introductionmentioning

confidence: 99%

“…Whatever the pathogenic basis of mediator release is, the occurrence of the respective symptoms has to be recognized as an important clinical sign to be addressed in these patients. Notably, in several cases fatal anaphylactoid reactions to insect stings, allergens, or other triggering factors have been reported [23, 24, 25, 26, 27, 28]. …”

Section: Introductionmentioning

confidence: 99%

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Indolent Systemic Mastocytosis with Elevated Serum Tryptase, Absence of Skin Lesions, and Recurrent Severe Anaphylactoid Episodes

Florian

Krauth²,

Simonitsch‐Klupp³

et al. 2005

Int Arch Allergy Immunol

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Background: In contrast to aggressive mastocytosis, patients with indolent systemic mastocytosis (ISM) usually present with urticaria pigmentosa-like skin lesions. In those who lack skin lesions, mastocytosis is often overlooked or confused with endocrinologic, allergic, or other internal disorders. Case Report and Results: We report on a 33-year-old male patient in whom severe hypotensive episodes occurred after contact with ants or yellow jackets. Since no specific IgE was detected, the serum tryptase concentration was measured and found to be clearly elevated (70 ng/ml). Consecutive staging and examination of the bone marrow revealed ISM. The patient was advised to circumvent insect contact, to take antihistamines on demand, and to carry an epinephrine self-injector for emergency events. In a retrospective analysis of 40 patients seen between 1988 and 2003, only 2 had a life-threatening mediator-related episode before ISM was diagnosed. Conclusions: Our report confirms the diagnostic value of tryptase in patients with suspected mastocytosis. In addition, the report suggests that the lack of typical skin lesions does not exclude an indolent form of mastocytosis even if the serum tryptase is clearly elevated. Finally, our case further shows that mastocytosis can be an important differential diagnosis to be considered in patients with unexplained anaphylactoid or other mediator-related symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Indolent Systemic Mastocytosis with Elevated Serum Tryptase, Absence of Skin Lesions, and Recurrent Severe Anaphylactoid Episodes

Florian

Krauth²,

Simonitsch‐Klupp³

et al. 2005

Int Arch Allergy Immunol

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“…However, given that the protective effect is lost once VIT is interrupted [109], it is currently accepted that lifelong treatment should be given to patients with ISM. Protocols of extended maintenance with doses every 12-16 weeks are well tolerated by such patients.…”

Section: Management Of Indolent Systemic Mastocytosis and Anaphylaxismentioning

confidence: 99%

Key Issues in Hymenoptera Venom Allergy: An Update

Alfaya

Soriano-Gomis

Mera

et al. 2017

J Investig Allergol Clin Immunol

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In this review, the Hymenoptera Allergy Committee of the SEAIC analyzes the most recent scientific literature addressing problems related to the diagnosis of hymenoptera allergy and to management of venom immunotherapy. Molecular diagnosis and molecular risk profiles are the key areas addressed. The appearance of new species of hymenoptera that are potentially allergenic in Spain and the associated diagnostic and therapeutic problems are also described. Finally, we analyze the issue of mast cell activation syndrome closely related to hymenoptera allergy, which has become a new diagnostic challenge for allergists given its high prevalence in patients with venom anaphylaxis.

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“…A generally accepted risk factor for recurrent severe anaphylaxis in SM is a known allergy against hymenoptera venom. In fact, various studies have shown that venom allergic patients with SM have a particularly high risk for developing severe, life-threatening anaphylactic events after hymenoptera stings [39][40][41][42][43][44].…”

Section: The Risk Of Severe Anaphylaxis (Mcas) In Mastocytosismentioning

confidence: 99%