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Safety and effectiveness of immunotherapy in patients with indolent systemic mastocytosis presenting with Hymenoptera venom anaphylaxis.

AbstractBACKGROUND:
Anaphylaxis after Hymenoptera sting has been described in patients with mastocytosis. Venom immunotherapy (VIT) is a safe and effective way to treat patients with Hymenoptera anaphylaxis, but few studies have addressed its usefulness in patients with systemic mastocytosis.
OBJECTIVE:
To study the effectiveness and safety of VIT in patients with systemic mastocytosis having anaphylaxis after Hymenoptera sting.
METHODS:
A total of 21 mastocytosis patients-4 women (19%) and 17 men (81%) with a median age of 50 years (range, 29-74 years)-with Hymenoptera sting anaphylaxis who were treated with VIT and followed for a median of 52 months (range, 2-250 months) were studied.
RESULTS:
In 18 of 21 patients-16 of them lacking skin involvement-anaphylaxis was the presenting symptom. Six patients (29%) experienced adverse reactions during VIT, 3 during initiation and 3 during maintenance. Twelve patients (57%) were resting while undergoing VIT; 9 (75%) presented local reactions and 3 (25%) systemic reactions, 1 of which required intubation. The Hymenoptera specific IgE decreased from 4.15 kU/L (range, 0.44-100 kU/L) before immunotherapy to 1.2 kU/L (range, 0.34-69.4 kU/L) after 4 years (P < .003).
CONCLUSION:
Venom immunotherapy is effective to treat IgE-mediated Hymenoptera anaphylaxis in patients with mastocytosis. Its use is recommended despite a relatively high risk of adverse reactions during the build-up phase because it provides protection from anaphylaxis in around 3/4 of the patients.
AuthorsDavid González de Olano, Iván Alvarez-Twose, María I Esteban-López, Laura Sánchez-Muñoz, María D Alonso Díaz de Durana, Arantza Vega, Andres García-Montero, Eloina González-Mancebo, Teresa Belver, María D Herrero-Gil, Montserrat Fernández-Rivas, Alberto Orfao, Belén de la Hoz, Mariana C Castells, Luis Escribano
JournalThe Journal of allergy and clinical immunology (J Allergy Clin Immunol) Vol. 121 Issue 2 Pg. 519-26 (Feb 2008) ISSN: 1097-6825 [Electronic] United States
PMID18177694 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Arthropod Venoms
  • Epitopes
  • Immunoglobulin E
Topics
  • Adult
  • Aged
  • Anaphylaxis (chemically induced, complications)
  • Animals
  • Arthropod Venoms
  • Cohort Studies
  • Epitopes
  • Female
  • Humans
  • Hymenoptera (immunology)
  • Immunoglobulin E (blood)
  • Immunotherapy (adverse effects)
  • Insect Bites and Stings (complications)
  • Male
  • Mastocytosis, Systemic (complications, therapy)
  • Middle Aged
  • Recurrence
  • Treatment Outcome

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