학술논문
Safety and effectiveness of immunotherapy in patients with indolent systemic mastocytosis presenting with Hymenoptera venom anaphylaxis
Document Type
Academic Journal
Author
de Olano, David González; Álvarez-Twose, Iván; Esteban-López, María I.; Sánchez-Muñoz, Laura; de Durana, María D. Alonso Díaz; Vega, Arantza; García-Montero, Andres; González-Mancebo, Eloina; Belver, Teresa; Herrero-Gil, María D.; Fernández-Rivas, Montserrat; Orfao, Alberto; de la Hoz, Belén; Castells, Mariana C.; Escribano, Luis
Source
The Journal of Allergy and Clinical Immunology. Feb 01, 2008 121(2):519-526
Subject
Language
English
ISSN
0091-6749
Abstract
BACKGROUND: 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 restung 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.