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Vol. 146, No. 2, 2008
Issue release date: May 2008
Int Arch Allergy Immunol 2008;146:162–163
(DOI:10.1159/000113520)

Fatal Anaphylactic Sting Reaction in a Patient with Mastocytosis

Wagner N. · Fritze D. · Przybilla B. · Hagedorn M. · Ruëff F.
aHautklinik und bMedizinische Klinik, Klinikum Darmstadt, Darmstadt, und cKlinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Deutschland

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Abstract

We report on a 33-year-old female patient with indolent systemic mastocytosis and urticaria pigmentosa who died of an anaphylactic reaction after a yellow jacket sting. As she had no history of previous anaphylactic sting reaction, there was no testing performed in order to detect hymenoptera venom sensitization. But even if a sensitization had been diagnosed, no venom immunotherapy (VIT) would have been recommended. It is almost certain that VIT would have saved her life and it is most likely that VIT is indicated in some patients with mastocytosis with no history of anaphylactic sting reaction. However, no criteria have been established in order to allow a selection of mastocytosis patients eligible for such a ‘prophylactic’ VIT.



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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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References

  1. Dubois AE: Mastocytosis and hymenoptera allergy. Curr Opin Allergy Clin Immunol 2004;4:291–295.
  2. Ruëff F, Placzek M, Przybilla B: Mastocytosis and hymenoptera venom allergy. Curr Opin Allergy Clin Immunol 2006;6:284–288.
  3. Ludolph-Hauser D, Ruëff F, Fries C, Schöpf P, Przybilla B: Constitutionally raised serum concentrations of mast-cell tryptase and severe anaphylactic reactions to hymenoptera stings. Lancet 2001;357:361–362.
  4. Oude Elberink JNG, de Monchy JGR, Kors JW, van Doormaal JJ, Dubois AEJ: Fatal anaphylaxis after a yellow jacket sting, despite venom immunotherapy, in two patients with mastocytosis. J Allergy Clin Immunol 1997;99:153–154.
  5. Reimers A, Müller U: Fatal outcome of a Vespula sting in a patient with mastocytosis after specific immunotherapy with honey bee venom. Allergy Clin Immunol Int J WAO Org 2005;17(suppl 1):69–70.
  6. Florian S, Krauth MT, Simonitsch-Klupp I, Sperr WR, Fritsche-Polanz R, Sonneck K, Fodinger M, Agis H, Bohm A, Wimazal F, Horny HP, Valent P: Indolent systemic mastocytosis with elevated serum tryptase, absence of skin lesions, and recurrent severe anaphylactoid episodes. Int Arch Allergy Immunol 2005;136:273–280.
  7. Fricker M, Helbling A, Schwartz L, Müller U: Hymenoptera sting anaphylaxis and urticaria pigmentosa: clinical findings and results of venom immunotherapy in ten patients. J Allergy Clin Immunol 1997;100:11–15.


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