title: Rush immunotherapy for wasp venom allergy seems safe and effective in patients with mastocytosis.
abstract: BACKGROUND
  Patients with mastocytosis and wasp venom allergy (WA) may benefit from venom immunotherapy (VIT). However, fatal insect sting reactions have been described in mastocytosis patients despite previous immunotherapy. We investigated the safety and efficacy of (rush) VIT in patients with mastocytosis and WA.
  
  
  OBJECTIVE
  To investigate the safety and efficacy of (rush) VIT in patients with mastocytosis and WA.
  
  
  METHODS
  We describe nine patients with cutaneous mastocytosis and WA who received VIT. Cutaneous mastocytosis was confirmed by histopathology and systemic mastocytosis was diagnosed according to World Health Organization criteria. VIT was given according to a rush protocol. Given the difference in safety and efficacy of VIT in patients with WA and honeybee venom allergy, we reviewed the literature for VIT with the focus on WA patients with mastocytosis and addressed the difference between patients with cutaneous versus systemic mastocytosis.
  
  
  RESULTS
  Nine patients had WA and mastocytosis, of whom six had cutaneous mastocytosis, two combined cutaneous and systemic mastocytosis and one systemic mastocytosis. All patients received rush IT with wasp venom. Most patients had only mild local side effects, with no systemic side effects during the course of VIT. One patient had a systemic reaction upon injection on one occasion, during the updosing phase, with dyspnoea and hypotension, but responded well to treatment. Immunotherapy was continued after temporary dose adjustment without problems. Two patients with a previous anaphylactic reaction were re-stung, without any systemic effects.
  
  
  CONCLUSIONS
  VIT is safe in cutaneous mastocytosis patients with WA, while caution has to be made in case of systemic mastocytosis. VIT was effective in the patients who were re-stung.
authors.affiliation: Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Verburg
authors.affiliation: Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Oldhoff
authors.affiliation: Department of Dermatology/Allergology University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. Phone: +31 88 7553 235 E-mail: r.j.b.klemans-3@umcutrecht.nl.
authors.forename: R J B
authors.initials: RJ
authors.lastname: Klemans
authors.affiliation: Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Lahey-de Boer
authors.affiliation: Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: M S
authors.initials: MS
authors.lastname: de Bruin-Weller
authors.affiliation: Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Röckmann
authors.affiliation: Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Sanders
authors.affiliation: Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: C A F M
authors.initials: CA
authors.lastname: Bruijnzeel-Koomen
authors.affiliation: Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: S G M A
authors.initials: SG
authors.lastname: Pasmans
authors.affiliation: Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Knulst
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D007299:Insect Bites and Stings / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D008297:Male; D034701:Mastocytosis, Cutaneous / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D034721:Mastocytosis, Systemic / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014862:Wasp Venoms / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D014863:Wasps / Q000276:immunology
chemical_list: D014862:Wasp Venoms
keywords: Immunotherapy; mastocytosis; tryptase; urticaria pigmentosa; wasp venom allergy; yellow jacket venom allergy