Higher mast cell load decreases the risk of Hymenoptera venom-induced anaphylaxis in patients with mastocytosis

van Anrooij, B., van der Veer, E., de Monchy, J. G. R., van der Heide, S., Kluin-Nelemans, J. C., van Voorst Vader, P. C., van Doormaal, J. J. & Oude Elberink, J. N. G., Jul-2013, In : Journal of Allergy and Clinical Immunology. 132, 1, p. 125-130 6 p.

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Background: Increased basal serum tryptase (bsT) levels are a well-described risk factor for Hymenoptera venom-induced anaphylaxis (HVAn) in patients allergic to Hymenoptera venom. Increased bsT levels might also indicate the presence of mastocytosis. In this study we evaluated whether the risk of HVAn increases with increasing mast cell load in patients with mastocytosis.

Methods: Consecutive patients with different subtypes of mastocytosis (n = 329) admitted to the University Medical Center Groningen were retrospectively assessed. As markers for mast cell load, levels of both bsT and the urinary histamine metabolites methylhistamine and methylimidazole acetic acid (MIMA) were used.

Results: In the entire patient group, irrespective of disease subtype and Hymenoptera venom exposure, HVAn prevalence gradually increased with increasing marker levels to a maximum of 36% to 47% at a bsT level of 28.0 mu g/L, a methylhistamine level of 231.0 mu mol/mol creatinine, and a MIMA level of 2.7 mmol/mol creatinine but decreased thereafter with a further increase in these levels. In patients with indolent systemic mastocytosis with a history of Hymenoptera venom exposure after age 15 years or greater (n = 152), MIMA and age at the most recent Hymenoptera sting were independent predictors for HVAn (odds ratios of 0.723 [P = .001] and 1.062 [P <.001], respectively).

Conclusions: In patients with mastocytosis, HVAn prevalence does not increase constantly with increasing levels of mast cell load parameters: after a gradual increase to a maximum of near 50%, it decreases with a further increase in these levels. In the indolent systemic mastocytosis population, all mast cell load markers were independent negative predictors of HVAn. These findings suggest a complex pathophysiologic association between mast cell load and HVAn risk in patients with mastocytosis.

Original languageEnglish
Pages (from-to)125-130
Number of pages6
JournalJournal of Allergy and Clinical Immunology
Issue number1
Publication statusPublished - Jul-2013


  • Hymenoptera venom-induced anaphylaxis, mastocytosis, tryptase, histamine metabolites, mast cell, INDOLENT SYSTEMIC MASTOCYTOSIS, LINE SERUM TRYPTASE, ALLERGY, IMMUNOTHERAPY, HISTAMINE, URINE, METABOLITES, DISORDERS, MUTATION, IMMUNITY

ID: 5899749