Hymenoptera Allergy and Mast Cell Activation Syndromes

  • Patrizia Bonadonna
  • Massimiliano Bonifacio
  • Carla Lombardo
  • Roberta Zanotti
Anaphylaxis and Drug Allergy (DA Khan and M Castells, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Anaphylaxis and Drug Allergy


Mast cell activation syndrome (MCAS) can be diagnosed in patients with recurrent, severe symptoms from mast cell (MC)-derived mediators, which are transiently increased in serum and are attenuated by mediator-targeting drugs. When KIT-mutated, clonal MC are detected in these patients, a diagnosis of primary MCAS can be made. Severe systemic reactions to hymenoptera venom (HV) represent the most common form of anaphylaxis in patients with mastocytosis. Patients with primary MCAS and HV anaphylaxis are predominantly males and do not have skin lesions in the majority of cases, and anaphylaxis is characterized by hypotension and syncope in the absence of urticaria and angioedema. A normal value of tryptase (≤11.4 ng/ml) in these patients does not exclude a diagnosis of mastocytosis. Patients with primary MCAS and HV anaphylaxis have to undergo lifelong venom immunotherapy, in order to prevent further potentially fatal severe reactions.


Systemic mastocytosis Mast cell activation syndromes Hymenoptera venom allergy Anaphylaxis Tryptase Clonal mast cell activation syndromes 


Compliance with Ethical Standards

Conflict of Interest

Dr. Bonifacio reports grants from Novartis Farma and personal fees from Ariad Pharmaceuticals and Amgen. Drs. Bonadonna, Bonifacio, Lombardo, and Zanotti declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Patrizia Bonadonna
    • 1
    • 3
  • Massimiliano Bonifacio
    • 2
    • 3
  • Carla Lombardo
    • 1
    • 3
  • Roberta Zanotti
    • 2
    • 3
  1. 1.Allergy UnitAzienda Ospedaliera Universitaria Integrata di VeronaVeronaItaly
  2. 2.Section of Hematology, Department of MedicineAzienda Ospedaliera Universitaria Integrata di VeronaVeronaItaly
  3. 3.Multidisciplinary Outpatients clinics for Mastocytosis (GISM)Azienda Ospedaliera Universitaria Integrata VeronaVeronaItaly

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