Mast cell diseases in patients with insect venom allergy: implications for diagnosis and therapy

ConclusionThe determination of baseline serum tryptase (bST) and an examination of the skin are recommended in all adult patients with a  previous history of systemic sting reactions. Patients with mastocytosis of the skin and/or bST elevated above 20 µg/l should always undergo further investigation. If bST is elevated in the absence of mastocytosis, or if a more accurate diagnosis of the mast cell disease is relevant, a so-cal led liquid biopsy can be performed, enabling a KIT mutation (tyrosine kinase receptor) to be investigated in peripheral blood. Bone marrow biopsy, bone density measurement, and upper abdominal ultrasound are also indicated. Due to the specific hazards posed by clonal mast cell diseases, HV-SIT is o f particular relevance to this patient group. Patients with clonal mast cell disease are at greater risk of treatment failure and should therefore undergo sting challenge. In bee venom allergy, one should try to achieve a higher maintenance dose (200 µg bee venom) from the start, likewise in pat ients with wasp venom allergy and sting reactions requiring resuscitation. Lifelong continuation of HV-SIT is recommended in mast cell disease.
Source: Allergo Journal International - Category: Allergy & Immunology Source Type: research