Usefulness of Omalizumab and Sting Challenge Test in Hymenoptera Venom Allergy and Mastocytosis

Abstract

A clear relationship has been demonstrated between hymenoptera venom anaphylaxis (HVA) and systemic mastocytosis (SM). In fact, up to 26% of the patients with a lifethreatening reaction after sting by bees and/or wasps present clonal mast cells (MCs) Venom immunotherapy (VIT) has proved to be effective in SM patients who have an IgE-mediated reaction, although there is a higher risk of adverse reactions than in the general population, especially in the build-up doses. Consequently, omalizumab may be of use while attempting to achieve maintenance [2]. VIT is effective in most patients treated and in around 75% of patients with SM [2], although no in vitro techniques are able to predict the effectiveness of treatment in a specific patient [3]. Sting challenge testing (SCT) has proven to be the most reliable method and the gold standard for monitoring the effectiveness of treatment [4]. Nevertheless, its use in patients at higher risk of reactions such as patients with clonal MC disease remains controversial.