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New Research - March 2009When is a bone marrow needed to evaluate for the presence of systemic mastocytosis in patients experiencing anaphylaxis to a hymenoptera sting?It is known that a certain percent of patients who experience anaphylaxis after an insect sting have mastocytosis. The authors wished to investigate this phenomenon further by studying patients presenting with anaphylactic reactions due to insect stings. They evaluated 379 subjects who had experienced an insect sting reaction by obtaining basal serum tryptase levels (at least two weeks after the reaction). If tryptase levels were greater than 11.4 ng/ml, subjects were evaluated further by bone marrow analysis (histology, flow cytometry, and detection of KIT mutations). Forty-four subjects had elevated baseline tryptase levels. Thirty-four of these underwent bone marrow analysis. The diagnosis of systemic mastocytosis was made in 21 (61.7%) of 34 subjects, and in 9 (26.5%), a diagnosis of mast cell activating syndrome was made. There are two important points made by this paper. The first is that the level of 20 ng/ml, previously thought as being the lowest abnormal value for serum tryptase, may be too high, and patients with mast cell activating disorders can be missed if that level is used to decide who needs to proceed with a bone marrow. The second point is that underlying systemic mastocytosis or a mast cell activating syndrome disorder may be more common than previously thought in patients experiencing anaphylactic reactions to hymenoptera stings. ReferenceBonadonna P, et al. Clonal mast cell disorders in patients with systemic reactions to hymenoptera stings and increased serum tryptase levels. Journal of Allergy and Clinical Immunology 2009; 123(3):680-686. |
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