Stegeman, K.L. (2016) Prevalence and patient characteristics of Indolent Systemic Mastocytosis (ISM) in patients with Hymenoptera allergy. thesis, Medicine.
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Abstract
Hymenoptera venom allergy (HVA) is a type I hypersensitivity reaction provoked by exposure to specific allergens in the venom at sting. Reactions to stings vary largely and range from innocent to severe or even fatal. Reactions at re-sting as well as efficacy of venom immunotherapy (VIT) depend on severity of the index sting reaction and the presence of an underlying mast cell disease known as indolent systemic mastocytosis (ISM). ISM is associated with more severe reactions and more side-effects during treatment. For effectiveness people with ISM require lifelong VIT. Suspicion for mastocytosis in HVA is based on elevated tryptase and/or MH and MIMA. So far, the prevalence of ISM in HVA patients is unknown. Furthermore, patients with ISM and HVA require lifelong VIT treatment to acquire effective protection. To investigate the prevalence of ISM in HVA patients, all adult HVA patients seen at the UMC Groningen between May 1st 2006 and December 31st 2015 (n=633) were investigated for reasons to suspect and the presence of ISM. Patient characteristics were investigated to determine predictors for HVA in ISM. In total 20 out of 633 (3.2%) of HVA patients were diagnosed with ISM, while at least 125 patients were suspected for ISM. A baseline serum tryptase level (bST) of higher than 11.4 μg/L was found to be the strongest predictor of ISM in HVA patients. Due to the limited amount of bone marrow (BM) evaluations (n=47) performed in this study, the prevalence found was limit and the possibility of missed cases of ISM is very likely. A BM evaluation should be performed in a HVA patient presenting with a grade IVB reaction with or without dermal symptoms at sting reaction, regardless of serum tryptase level or a HVA patient presenting with a grade IV (A or B) reaction with a serum tryptase > 10.0 μg/L. If a HVA patient presents with a grade IVA (or lower) reaction and only MIMA is elevated, the MIMA measurement should be repeated.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor: and Oude Elberink, J.N.G. MD PhD and Department of Internal Medicine – Allergology and UMC Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:50 |
| Last Modified: | 25 Jun 2020 10:50 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1130 |
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