Insect Sting Anaphylaxis—Or Mastocytosis—Or Something Else?

David B.K. Golden, Melody C. Carter

Research output: Contribution to journalArticlepeer-review

Abstract

Insect sting anaphylaxis and mast cell disorders are intertwined in a specific and unusual way. There may be specific subsets of clonal mast cell disorders that are predisposed to sting anaphylaxis. The clinical characteristics of the sting reactions should raise suspicion of underlying mastocytosis (eg, hypotension without hives especially in a male). A baseline serum tryptase level is helpful in the evaluation of patients with insect sting anaphylaxis because it correlates with important risks for these patients, and they have a high frequency of abnormally elevated baseline levels. Elevated baseline serum tryptase level has been reported to correlate with clonal mast cell disease in patients with insect sting anaphylaxis but may also indicate one of several possible underlying syndromes, including mast cell activation syndrome (MCAS), familial hypertryptasemia, and idiopathic anaphylaxis. There is some overlap in these conditions, so it is important to evaluate the clinical pattern at presentation as well as laboratory markers, and to consider bone marrow biopsy to make a final and specific diagnosis of clonal mast cell disease. The presence of venom-IgE does not prove that the patient's previous sting reactions were IgE-mediated, but even low levels of venom-IgE in patients with mastocytosis predispose to severe sting anaphylaxis. Evaluation of all these possible factors will affect the recommendation for venom immunotherapy.

Original languageEnglish (US)
Pages (from-to)1117-1123
Number of pages7
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume7
Issue number4
DOIs
StatePublished - Apr 2019

Keywords

  • Alpha-gal
  • Alpha-tryptasemia
  • Anaphylaxis
  • Idiopathic anaphylaxis
  • Insect allergy
  • Insect venom
  • Mastocytosis
  • Tryptase

ASJC Scopus subject areas

  • Immunology and Allergy

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