Skip to main content
SpringerLink
Log in

Mastocytosis as a risk factor for insect venom allergy

  • Übersicht
  • Mastocytosis as a risk factor for insect venom allergy
  • Published:
Allergo Journal Aims and scope Submit manuscript

Abstract

Background: Clonal mast cell disorders (CMD) are characterised by the proliferation and accumulation of mast cells in bone marrow, skin and other tissues. The prevalence of CMD in patients with systemic hymenoptera venom allergy (HVA) is higher than in the general population.

Methods: A review based on evidence from a thorough search in MEDLINE of the literature on CMD and its connection to HVA is presented.

Results: Hymenoptera venom sting represents the most common trigger of anaphylaxis in adult mastocytosis patients and the anaphylactic reactions of patients with CMD and HVA are characterised by the absence of angioedema and erythema and the predominance of cardiovascular symptoms.

Conclusions: Mastocytosis represents a risk factor for severe reaction in patients with HVA. An early diagnosis of CMD in these patients is very important since they are at high risk of severe osteoporosis and early therapy can be immediately started. Moreover, proper advice and prescription of adrenaline can be assessed. Finally, in order to stop venom immunotherapy or whether to continue it lifelong, diagnosis of CMD has to be carried out.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Atiakshin D, Buchwalow I, Samoilova V, Tiemann M. Tryptase as a polyfunctional component of mast cells. Histochem Cel lBiol 2018;149:461-77

  2. Ruëff F, Przybilla B, Biló MB, Müller U, Scheipl F, Aberer W, et al. Predictorsofseveresystemicanaphylacticreactionsin patients with hymenoptera venom allergy: importance of baselineserum tryptase - a study of the European academy of allergology and clinical immunology interest group on insect venom hypersensitivity. J Allergy Clin Immunol 2009;124:1047-54

  3. Horny HP, Akin C, Metcalfe DD, et al. World health organization (WHO) classification of tumours. 4th ed. Lyon: IARC Press; 2008.

  4. Longley BJ, Tyrrell L, Lu SZ, Ma YS, Langley K, Ding TG, et al. Somatic c-KIT activating mutation in urticaria pigmentosa and aggressive mastocytosis: establishment of clonality in a human mast cell neoplasm. Nat Genet 1996;12:312-4

  5. Bodemer C, Hermine O, Palmérini F, Yang Y, GrandpeixGuyodo C, Leventhal PS, et al. Pediatric mastocytosis is a clonal disease associated with D816V and other activating c-KIT mutations. J Invest Dermatol 2010;130:804-15

  6. van Doormaal JJ, Arends S, Brunekreeft KL, van der Wal VB, Sietsma J, van Voorst Vader PC, et al. Prevalence of indolent systemic mastocytosis in a Dutch region. J Allergy Clin Immunol 2013;131:1429-1431.e1.

  7. Sonneck K, Florian S, Müllauer L, Wimazal F, Födinger M, Sperr WR, et al. Diagnostic and subdiagnostic accumulation of mast cells in the bone marrow of patients with anaphylaxis: monoclonal mast cell activation syndrome. Int Arch Allergy Immunol 2007;142:158-64

  8. Alvarez-Twose I, Gonzalez de Olano D, Sanchez-Munoz L, Matito A, Esteban-López MI, Vega A, et al. Clinical, biological and molecular characteristics of systemic mast cell disorders presenting with severe mediator-related symptoms. J Allergy Clin Immunol 2010;125:1269-78

  9. Bonadonna P, Perbellini O, Passalacqua G, Caruso B, Colarossi S, Dal Fior D, et al. Clonal mast cell disorders in patientswith systemic reactions tohymenoptera stings and increased serum tryptase levels. J Allergy Clin Immunol. 2009;123:680-6

  10. Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016;127:2391-405

  11. Hartmann K, Escribano L, Grattan C, Brockow K,Carter MC, Alvarez-Twose I, et al. Cutaneous manifestations in patients with mastocytosis: consensus report of the European competence network on mastocytosis; the American academy of allergy, asthma & immunology; and the European academy of allergology and clinical immunology. J Allergy Clin Immunol 2016;137:35-45

  12. Pieri L, Bonadonna P, Elena C, Papayannidis C, Grifoni FI, Rondoni M, et al. Clinical presentation and management practice of systemic mastocytosis. A survey on 460 Italian patients. Am J Hematol 2016;91:692-9

  13. Valent P, Horny H-P, Li CY, et al. Tumours of haematopoietic andlymphoid tissues. Lyon: IARCPress; 2001

  14. Zanotti R, Bonadonna P, Bonifacio M, Artuso A, Schena D, RossiniM, et al. Isolated bone marrow mastocytosis: an underestimated subvariant of indolent systemic mastocytosis. Haematologica 2011;96:482-4

  15. Lim KH, Tefferi A, Lasho TL, Finke C, Patnaik M, Butterfield JH, et al. Systemic mastocytosis in 342 consecutive adults: survival studies and prognostic factors. Blood. 2009;113:5727-36

  16. Escribano L, Alvarez-Twose I, Sánchez-Muñoz L, Garcia Montero A, Núñez R, Almeida J, et al. Prognosis in adult indolent systemic mastocytosis: a long-term study of the Spanish network on mastocytosis in a series of 145 patients. J Allergy Clin Immunol 2009;124:514-21

  17. Akin C, Scott LM, Kocabas CN, Kushnir-Sukhov N, Brittain E, Noel P, et al. Demonstration of an aberrant mast-cell population with clonal markers in a subset of patients with "idiopathic" anaphylaxis. Blood 2007;110:2331-3

  18. Pardanani A, Tefferi A. Proposal for a revised classification of systemic mastocytosis. Blood 2010;115:2720-1

  19. Bonadonna P, Zanotti R, Pagani M, Caruso B, Perbellini O, Colarossi S, et al. How much specific is the association between hymenoptera venom allergy and mastocytosis? Allergy 2009;64:1379-82

  20. Gülen T, Hägglund H, Dahlén B, Nilsson G. High prevalence of anaphylaxis in patients with systemic mastocytosis - a single-centre experience. Clin Exp Allergy. 2014;44:121-9

  21. González de Olano D, de la Hoz Caballer B, Núñez López R, Sánchez Muñoz L, Cuevas Agustín M, Diéguez MC, et al. Prevalence of allergy and anaphylactic symptoms in 210 adult and pediatric patients with mastocytosis in Spain: a study of the Spanish network on mastocytosis (REMA). Clin Exp Allergy 2007;37:1547-55

  22. Brockow K, Jofer C, Behrendt H, Ring J. Anaphylaxis in patients with mastocytosis: a study on history, clinical features and risk factors in 120 patients. Allergy 2008;63:226-32

  23. Alvarez-Twose I, Zanotti R, González-de-Olano D, Bonadonna P, Vega A, Matito A, et al. Nonaggressive systemic mastocytosis (SM) without skin lesions associated with insect-induced anaphylaxis shows unique features versus other indolent SM. J Allergy Clin Immunol 2014;133:520-8

  24. Castells MC, Hornick JL, Akin C. Anaphylaxis after hymenoptera sting: is it venom allergy, a clonal disorder, or both? J Allergy Clin Immunol Pract 2015;3:350-5

  25. Van Anrooij B, van der Veer E, deMonchy JG, van der Heide S, Kluin-Nelemans JC, van Voorst Vader PC, et al. Higher mast cell load decreases the risk ofhymenoptera venom-induced anaphylaxis in patients with mastocytosis. J Allergy Clin Immunol 2013;132:125-30

  26. Wimazal F, Geissler P, Shnawa P, Sperr WR, Valent P. Severe life-threatening or disabling anaphylaxis in patients with systemic mastocytosis: a single-center experience. Int Arch Allergy Immunol 2012;157:399-405

  27. Bonadonna P, Bonifacio M, Lombardo C, Zanotti R. Hymenoptera allergy and mast cell activation syndromes. Curr Allergy Asthma Rep 2016;16:5

  28. Bonadonna P, Scaffidi L, Boni E. Tryptase values in anaphylaxis and insect allergy. Curr Opin Allergy Clin Immunol 2019;19:462-7

  29. Bilò BM, Ruëff F, Mosbech H, Bonifazi F, Oude-Elberink JN. Diagnosis of hymenoptera venom allergy. Allergy 2005;60:1339-49

  30. Niedoszytko M, de Monchy J, van Doormaal JJ, Jassem E, Oude Elberink JN. Mastocytosis and insect venom allergy: diagnosis, safety and efficacy of venom immunotherapy. Allergy 2009;64:1237-45

  31. Bonadonna P, Lombardo C, Zanotti R. Mastocytosis and allergic diseases. J Investig Allergol Clin Immunol 2014;24:288-97

  32. Haeberli G, Bronnimann M, Hunziker T, Muller U. Elevated basalserum tryptase and hymenoptera venom allergy: relation to severity of sting reactions and to safety and efficacy of venom immunotherapy. ClinExpAllergy 2003;33:1216-20

  33. Rueff F, Placzek M, Przybilla B. Mastocytosis and hymenoptera venom allergy. Curr Opin Allergy Clin Immunol 2006;6:284-8

  34. Cohen SS, Skovbo S, Vestergaard H, Kristensen T, Møller M, Bindslev-Jensen C, et al. Epidemiology of systemic mastocytosis in Denmark. Br J Haematol 2014;166:521-8

  35. Potier A, Lavigne C, Chappard D, Verret JL, Chevailler A, Nicolie B, et al. Cutaneous manifestations in hymenoptera and diptera anaphylaxis: relationship with basal serum tryptase. ClinExpAllergy 2009;39:717-25

  36. Guenova E, Volz T, Eichner M, Hoetzenecker W, Caroli U, Griesinger G, et al. Basal serum tryptase as risk assessment for severe hymenoptera sting reactions in elderly. Allergy 2010;65:919-23

  37. Zanotti R, Lombardo C, Passalacqua G, Caimmi C, Bonifacio M, De Matteis G, et al. Clonal mast cell disorders in patients with severe hymenoptera venom allergy and normal serum tryptase levels. J Allergy Clin Immunol 2015;136:135-9

  38. Bonadonna P, Zanotti R, Melioli G, Antonini F, Romano I, Lenzi L, et al. The role of basophil activation test in special populations with mastocytosis and reactions to hymenoptera sting. Allergy 2012;67:962-5

  39. Bonadonna P, Gonzalez-de-Olano D, Zanotti R, Riccio A, De Ferrari L, Lombardo C, et al. Venom immunotherapy in patients with clonal mast cell disorders: efficacy, safety, and practical considerations. J Allergy Clin Immunol Pract 2013;1:474-8

  40. Bilò MB, Pravettoni V, Bignardi D, Bonadonna P, Mauro M, Novembre E, et al. Hymenoptera venom allergy: management of children and adults in clinical practice. J Investig Allergol Clin Immunol 2019;29:180-205

  41. Michel J, Brockow K, Darsow U, Ring J, Schmidt-Weber CB, Grunwald T, et al. Added sensitivity of component-resolved diagnosis in hymenoptera venom-allergic patients with elevated serum tryptase and/or mastocytosis. Allergy 2016;71:651-60

  42. Perbellini O, Zamò A, Colarossi S, Zampieri F, Zoppi F, Bonadonna P, et al. Primary role of multi parametric flow cytometry in the diagnostic work-up of indolent clonal mast cell disorders. Cytometry B Clin Cytom 2011; 80:362-8

  43. Alvarez-Twose I, González-de-Olano D, Sánchez-Muñoz L, MatitoA, Jara-Acevedo M,Teodosio C, et al. Validation of the REMA score for predicting mast cell clonality and systemic mastocytosis in patients with systemic mast cell activation symptoms. Int Arch Allergy Immunol 2012;157:275-80

  44. González-de-Olano D, Alvarez-Twose I, Morgado JM, Esteban-López MI, Vega Castro A, Díaz de Durana MD, et al. Evaluation of basophil activation in mastocytosis with hymenoptera venom anaphylaxis. Cytometry B Clin Cytom 2011;80:167-75

  45. Bonadonna P, Zanotti R, Pagani M, Bonifacio M, Scaffidi L, Olivieri E, et al. Anaphylactic reactions after discontinuation of hymenoptera venom immunotherapy: a clonal mast cell disorder should be suspected. J Allergy Clin Immunol Pract 2018;6:1368-72

Download references

Acknowledgement

This work was partially presented as a lecture in the EAACI Allergy School on Insect Venom Allergy and Mastocytosis held in Groningen, The Netherlands, April 11-13, 2019.

Author information

Authors and Affiliations

  1. Allergy Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italien

    Patrizia Bonadonna

  2. Allergy Unit, Hospital Santo Spirito, ASLAL, Alessandria, Italien

    Elisa Boni

  3. Multidisciplinary Outpatients Clinic for Mastocytosis (GISM), Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italien

    Roberta Zanotti

Authors
  1. Patrizia Bonadonna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elisa Boni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roberta Zanotti
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors performed the literature search and data analysis and revised the work.

Corresponding author

Correspondence to Elisa Boni.

Ethics declarations

P. Bonadonna, E. Boni and R. Zanotti declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bonadonna, P., Boni, E. & Zanotti, R. Mastocytosis as a risk factor for insect venom allergy. Allergo J 29, 32–37 (2020). https://doi.org/10.1007/s15007-020-2516-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15007-020-2516-3

Keywords

Search

Navigation