Venom Allergy In Systemic Mastocytosis

Abstract

RationaleTo analyze venom allergy in patients with systemic mastocytosis (SM).MethodsA retrospective chart review of 168 patients with a diagnosis of SM between 1997 and 2009 was performed after institutional IRB approval.ResultsThe rate of venom allergy in our SM population was found to be 12.5% (21/168). Male: female ratio was 3:4. The insects were identified in 12 cases, and honey bee (4) and yellow jacket (4) predominated. Baseline tryptase was elevated in all but 2 patients and unavailable in 3 others. Baseline urine n-methyl histamine excretion was elevated in 7 out of 10 patients measured and urine beta prostaglandin (PG) alpha excretion was elevated in 11 out of 11 patients. 6/21 patients had other atopic diseases. 15/21 patients were found to have allergies to medications and 7/15 had intra procedural/intraoperative reactions. Out of 21 patients, 7 were not seen by an allergist and none of the 7 was carrying an Epinephrine Autoinjector. Immunotherapy data was available on 11 patients. Of 4 patients receiving immunotherapy, 2 required dosage adjustments during build up and 1 had a severe reaction requiring ER visit and subsequent pretreatment to build up to maintenance.ConclusionThis study confirms the high rate of venom allergy in SM (12.5%) compared to the general population (0.5-3%). 24 hour urine mediators were elevated in a majority of patients tested and can add to the diagnostic value. Our experience suggests that the frequency of vespid allergy in SM is increased, and that a substantial number of these patients remain sub-optimally treated. RationaleTo analyze venom allergy in patients with systemic mastocytosis (SM). To analyze venom allergy in patients with systemic mastocytosis (SM). MethodsA retrospective chart review of 168 patients with a diagnosis of SM between 1997 and 2009 was performed after institutional IRB approval. A retrospective chart review of 168 patients with a diagnosis of SM between 1997 and 2009 was performed after institutional IRB approval. ResultsThe rate of venom allergy in our SM population was found to be 12.5% (21/168). Male: female ratio was 3:4. The insects were identified in 12 cases, and honey bee (4) and yellow jacket (4) predominated. Baseline tryptase was elevated in all but 2 patients and unavailable in 3 others. Baseline urine n-methyl histamine excretion was elevated in 7 out of 10 patients measured and urine beta prostaglandin (PG) alpha excretion was elevated in 11 out of 11 patients. 6/21 patients had other atopic diseases. 15/21 patients were found to have allergies to medications and 7/15 had intra procedural/intraoperative reactions. Out of 21 patients, 7 were not seen by an allergist and none of the 7 was carrying an Epinephrine Autoinjector. Immunotherapy data was available on 11 patients. Of 4 patients receiving immunotherapy, 2 required dosage adjustments during build up and 1 had a severe reaction requiring ER visit and subsequent pretreatment to build up to maintenance. The rate of venom allergy in our SM population was found to be 12.5% (21/168). Male: female ratio was 3:4. The insects were identified in 12 cases, and honey bee (4) and yellow jacket (4) predominated. Baseline tryptase was elevated in all but 2 patients and unavailable in 3 others. Baseline urine n-methyl histamine excretion was elevated in 7 out of 10 patients measured and urine beta prostaglandin (PG) alpha excretion was elevated in 11 out of 11 patients. 6/21 patients had other atopic diseases. 15/21 patients were found to have allergies to medications and 7/15 had intra procedural/intraoperative reactions. Out of 21 patients, 7 were not seen by an allergist and none of the 7 was carrying an Epinephrine Autoinjector. Immunotherapy data was available on 11 patients. Of 4 patients receiving immunotherapy, 2 required dosage adjustments during build up and 1 had a severe reaction requiring ER visit and subsequent pretreatment to build up to maintenance. ConclusionThis study confirms the high rate of venom allergy in SM (12.5%) compared to the general population (0.5-3%). 24 hour urine mediators were elevated in a majority of patients tested and can add to the diagnostic value. Our experience suggests that the frequency of vespid allergy in SM is increased, and that a substantial number of these patients remain sub-optimally treated. This study confirms the high rate of venom allergy in SM (12.5%) compared to the general population (0.5-3%). 24 hour urine mediators were elevated in a majority of patients tested and can add to the diagnostic value. Our experience suggests that the frequency of vespid allergy in SM is increased, and that a substantial number of these patients remain sub-optimally treated.