title: Venom immunotherapy in patients with clonal mast cell disorders: efficacy, safety, and practical considerations.
abstract: BACKGROUND
  A preferential association between systemic mastocytosis (SM) and hymenoptera allergy (HVA) has been observed. Patients with both diseases are at risk for more severe reactions, and venom immunotherapy (VIT) may represent a life-saving treatment, but the use of VIT in such patients raised concerns about its safety.
  
  
  OBJECTIVE
  We evaluated a large population of patients with SM and HVA who received VIT.
  
  
  METHODS
  This prospective study was performed in Italy and Spain. A diagnosis of SM and HVA and a VIT prescription were made according to international recommendations. The patients were carefully followed up during VIT, with special attention to field stings.
  
  
  RESULTS
  A total of 84 patients (70 men, 14 women; mean age 52.1 years) were included, 81% with grade IV reaction, 91% with indolent SM. No difference was seen between the Italian and Spanish patients. There were 10 adverse reactions during the induction phase: 3 with the conventional induction and 7 with the rush-modified induction, none resulted in epinephrine administration and/or hospitalization. Fifty patients had one or more field re-sting (95 episodes), none during induction. The time elapsed from starting VIT and first re-sting was 2 months to 7 years, and the number of re-stings per patient was 1-6. Of the 50 patients who were re-stung, 43 (86%) resulted in being fully protected. Seven patients had reactions, and the maintenance dose was safely increased to 200 mcg. The maintenance dose interval was not different between patients with and those without reactions at re-stings.
  
  
  CONCLUSIONS
  VIT is well tolerated, safe, and effective in patients with SM.
authors.affiliation: Allergy Unit, Azienda Ospedale Università di Verona, Verona, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Bonadonna
authors.affiliation: Allergy Unit, Hospital Universitario de Fuenlabrada, Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Gonzalez-de-Olano
authors.affiliation: Haematology Section, Department of Clinical and Experimental Medicine, University of Verona, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Zanotti
authors.affiliation: Allergy and Respiratory Diseases, IRCCS San Martino IST, University of Genoa, Genoa, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Riccio
authors.affiliation: Allergy and Respiratory Diseases, IRCCS San Martino IST, University of Genoa, Genoa, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: De Ferrari
authors.affiliation: Allergy Unit, Azienda Ospedale Università di Verona, Verona, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Lombardo
authors.affiliation: Allergy and Respiratory Diseases, IRCCS San Martino IST, University of Genoa, Genoa, Italy.
authors.forename: Anthi
authors.initials: A
authors.lastname: Rogkakou
authors.affiliation: Centro de Estudios de Mastocitosis de Castilla la Mancha, Hospital Virgen del Valle, Toledo, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Escribano
authors.affiliation: Centro de Estudios de Mastocitosis de Castilla la Mancha, Hospital Virgen del Valle, Toledo, Spain.
authors.forename: Ivan
authors.initials: I
authors.lastname: Alvarez-Twose
authors.affiliation: Centro de Estudios de Mastocitosis de Castilla la Mancha, Hospital Virgen del Valle, Toledo, Spain.
authors.forename: Almudena
authors.initials: A
authors.lastname: Matito
authors.affiliation: Allergy Unit, Hospital Universitario de Guadalajara, Guadalajara, Spain.
authors.forename: Arantza
authors.initials: A
authors.lastname: Vega
authors.affiliation: Allergy and Respiratory Diseases, IRCCS San Martino IST, University of Genoa, Genoa, Italy. Electronic address: passalacqua@unige.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Passalacqua
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001180:Arthropod Venoms / Q000276:immunology*; D003888:Desensitization, Immunologic / Q000009:adverse effects; D005260:Female; D006801:Humans; D006927:Hymenoptera / Q000276:immunology*; D006967:Hypersensitivity / Q000628:therapy*; D008297:Male; D008415:Mastocytosis / Q000628:therapy*; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D001180:Arthropod Venoms
keywords: Efficacy; Hymenoptera allergy; Safety; Systemic mastocytosis; Venom immunotherapy