Fatal Anaphylaxis to Yellow Jacket Stings in Mastocytosis: Options for Identification and Treatment of At-Risk Patients

The Journal of Allergy and Clinical Immunology. in Practice
Byrthe J P R VosJoanne N G Oude Elberink

Abstract

Patients with indolent systemic mastocytosis (ISM) are at risk for severe anaphylactic reactions to yellow jacket (YJ) stings while demonstration of sensitization can be challenging because specific IgE (sIgE) levels are regularly below 0.35 kUA/L. The implication of missing YJ allergy is illustrated by a case of fatal anaphylaxis. To explore the natural course of YJ venom allergy and the diagnostic accuracy and therapeutic consequence of YJ venom sIgE in patients with ISM. All patients with ISM seen from 1981 to 2015 (n = 243) were evaluated on the number of YJ stings, reaction severity, and sensitivity and specificity of YJ venom sIgE. YJ venom allergic patients without mastocytosis served as control (n = 313). A total of 153 patients with ISM were stung during adult life. The first systemic reaction was more often severe in patients with ISM than in patients without mastocytosis (69.9% vs 22.0%) and reactions recurred in 40 of 41 re-stung patients with ISM. ISM reactors showed lower YJ venom sIgE levels than nonmastocytosis reactors (0.61 vs 4.83 kUA/L; P < .001) and asymptomatic sensitization was exceedingly rare. In ISM the current clinical threshold of 0.35 kUA/L yields a sensitivity and specificity of 77.6% and 87.5%, re...Continue Reading

Citations

Jul 26, 2019·Current Opinion in Allergy and Clinical Immunology·Maria B BilòSimon Blank
Jul 2, 2019·Current Opinion in Allergy and Clinical Immunology·Iván Alvarez-Twose, Almudena Matito
Jul 11, 2020·Current Allergy and Asthma Reports·Simon BlankThilo Jakob
Jun 14, 2019·Allergy·Johanna StoevesandtAxel Trautmann
Aug 11, 2017·Current Opinion in Allergy and Clinical Immunology·Knut Brockow, Cem Akin
Feb 5, 2021·International Journal of Molecular Sciences·Jan RomantowskiPeter Valent
Mar 3, 2021·Human Vaccines & Immunotherapeutics·Ali Selcuk, Abdullah Baysan
Mar 6, 2021·Current Allergy and Asthma Reports·David B K Golden
Apr 8, 2021·Current Allergy and Asthma Reports·Irene MikhailBenjamin T Prince
May 12, 2021·The Journal of Allergy and Clinical Immunology. in Practice·Leander P De PuysseleyrVito Sabato

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