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#Allergy and Immunology #Internal Medicine #Public Health
A new study published in Allergy evaluated the efficacy and safety of venom-immunotherapy (VIT) in hymenoptera venom anaphylaxis (HVA) patients with clonal mast cell disorders (cMCD). This retrospective study was conducted among 46 patients with Vespula-venom allergy who had experienced severe HVA. Among these, 32 were cMCD – 22 with systemic mastocytosis (SM) and 10 with monoclonal mast cell activation syndrome (MMAS), and 14 were controls. There were no differences between cMCD patients and controls in age and duration of VIT. The results revealed that during VIT, 34% cMCD patients experienced adverse reactions (ARs), including 1 anaphylaxis, while the rate of ARs was 7% in controls. There were 23 re-sting episodes in 53% patients during VIT. Of the episodes, 17% presented with anaphylaxis, 60% with local reaction, and 23% were asymptomatic. In 48% of the episodes, patients did not take epinephrine; of these 73% presented with local reaction and 27% were asymptomatic. Patient-based protection from anaphylaxis was 76% in cMCD versus 100% in controls during VIT. Additionally, the venom-specific IgG4 levels increased during VIT, but tryptase and IgE levels were unaltered. Thus, both safety and efficacy of VIT in cMCD patients was slightly reduced than controls; severe ARs were rare. From the findings, it was concluded that elevated IgG4 levels may be a biomarker for efficacy of VIT in cMCD patients, as it correlates to protection from re-stings.