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Alvarez-Twose I, Zanotti R, González-de-Olano D, Bonadonna P, Vega A, Matito A, Sánchez-Muñoz L, Morgado JM, Perbellini O, García-Montero A, De Matteis G, Teodósio C, Rossini M, Jara-Acevedo M, Schena D, Mayado A, Zamò A, Mollejo M, Sánchez-López P, Cabañes N, Orfao A, Escribano L. Nonaggressive systemic mastocytosis (SM) without skin lesions associated with insect-induced anaphylaxis shows unique features versus other indolent SM. J Allergy Clin Immunol 2013; 133:520-8. [PMID: 23921094 DOI: 10.1016/j.jaci.2013.06.020] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/06/2013] [Accepted: 06/17/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Indolent systemic mastocytosis (ISM) without skin lesions (ISMs(-)) shows a higher prevalence in males, lower serum baseline tryptase levels, and KIT mutation more frequently restricted to bone marrow (BM) mast cells (MCs) than ISM with skin lesions (ISMs(+)). Interestingly, in almost one-half of ISMs(-) patients, MC-mediator release episodes are triggered exclusively by insects. OBJECTIVE We aimed to determine the clinical and laboratory features of ISMs(-) associated with insect-induced anaphylaxis (insectISMs(-)) versus other patients with ISM. METHODS A total of 335 patients presenting with MC activation syndrome, including 143 insectISMs(-), 72 ISMs(-) triggered by other factors (otherISMs(-)), 56 ISMs(+), and 64 nonclonal MC activation syndrome, were studied. RESULTS Compared with otherISMs(-) and ISMs(+) patients, insectISMs(-) cases showed marked male predominance (78% vs 53% and 46%; P < .001), a distinct pattern of MC-related symptoms, and significantly lower median serum baseline tryptase levels (22.4 vs 28.7 and 45.8 μg/L; P ≤ .009). Moreover, insectISMs(-) less frequently presented BM MC aggregates (46% vs 70% and 81%; P ≤ .001), and they systematically showed MC-restricted KIT mutation. CONCLUSIONS ISMs(-) patients with anaphylaxis triggered exclusively by insects display clinical and laboratory features that are significantly different from other ISM cases, including other ISMs(-) and ISMs(+) patients, suggesting that they represent a unique subgroup of ISM with a particularly low BM MC burden in the absence of adverse prognostic factors.
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Affiliation(s)
- Iván Alvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Spain; Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain.
| | - Roberta Zanotti
- Section of Haematology, Department of Medicine, University of Verona, Verona, Italy; Multidisciplinary Outpatients Clinics for Mastocytosis, Verona, Italy
| | - David González-de-Olano
- Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain; Allergy Unit, Hospital de Fuenlabrada, Madrid, Spain
| | - Patrizia Bonadonna
- Multidisciplinary Outpatients Clinics for Mastocytosis, Verona, Italy; Allergy Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Arantza Vega
- Allergy Department, Hospital de Guadalajara, Guadalajara, Spain
| | - Almudena Matito
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Spain; Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
| | - Laura Sánchez-Muñoz
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Spain; Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
| | - José Mário Morgado
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Spain; Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
| | - Omar Perbellini
- Section of Haematology, Department of Medicine, University of Verona, Verona, Italy; Multidisciplinary Outpatients Clinics for Mastocytosis, Verona, Italy
| | - Andrés García-Montero
- Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain; Centro de Investigación del Cáncer/IBMCC (USAL/CSIC) and IBSAL, Departamento de Medicina and Servicio General de Citometría, University of Salamanca, Salamanca, Spain
| | - Giovanna De Matteis
- Multidisciplinary Outpatients Clinics for Mastocytosis, Verona, Italy; Clinical Chemistry and Haematology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Cristina Teodósio
- Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain; Centro de Investigación del Cáncer/IBMCC (USAL/CSIC) and IBSAL, Departamento de Medicina and Servicio General de Citometría, University of Salamanca, Salamanca, Spain
| | - Maurizio Rossini
- Multidisciplinary Outpatients Clinics for Mastocytosis, Verona, Italy; Section of Rheumatology, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - María Jara-Acevedo
- Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain; Centro de Investigación del Cáncer/IBMCC (USAL/CSIC) and IBSAL, Departamento de Medicina and Servicio General de Citometría, University of Salamanca, Salamanca, Spain
| | - Donatella Schena
- Multidisciplinary Outpatients Clinics for Mastocytosis, Verona, Italy; Section of Dermatology, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Andrea Mayado
- Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain; Centro de Investigación del Cáncer/IBMCC (USAL/CSIC) and IBSAL, Departamento de Medicina and Servicio General de Citometría, University of Salamanca, Salamanca, Spain
| | - Alberto Zamò
- Multidisciplinary Outpatients Clinics for Mastocytosis, Verona, Italy; Department of Pathology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Manuela Mollejo
- Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain; Pathology Department, Hospital Virgen de la Salud, Toledo, Spain
| | | | | | - Alberto Orfao
- Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain; Centro de Investigación del Cáncer/IBMCC (USAL/CSIC) and IBSAL, Departamento de Medicina and Servicio General de Citometría, University of Salamanca, Salamanca, Spain
| | - Luis Escribano
- Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
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