Castells Mariana C, Hornick Jason L, Akin Cem
Mastocytosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
Mastocytosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
J Allergy Clin Immunol Pract. 2015 May-Jun;3(3):350-5. doi: 10.1016/j.jaip.2015.03.015. Epub 2015 Apr 7.
A 47-year-old man presented with loss of consciousness 5 minutes after being stung by a yellow jacket in his backyard. Epinephrine and fluids were required for resuscitation. Allergy evaluation revealed specific IgE to yellow jacket and honeybee, and the patient was started on venom immunotherapy. He had systemic reactions during buildup and a severe anaphylactic episode requiring 3 doses of intramuscular epinephrine at maintenance doses. Immunotherapy was discontinued. Serum tryptase level after 1 such episode was 29 ng/mL, with a baseline level of 25 ng/mL 4 weeks later. The physical examination was unremarkable including no skin lesions of cutaneous mastocytosis. Because of elevated baseline tryptase level, a bone marrow biopsy was performed, which revealed multifocal dense infiltrates of mast cells. A diagnosis of systemic mastocytosis was made. The patient was treated with omalizumab and was able to tolerate immunotherapy and is currently maintained on lifelong immunotherapy. He was restung in the field and has not had anaphylaxis.
一名47岁男性在自家后院被黄蜂蜇伤5分钟后出现意识丧失。复苏时需要使用肾上腺素和补液。过敏评估显示对黄蜂和蜜蜂有特异性IgE，患者开始接受毒液免疫疗法。在剂量递增阶段他出现了全身反应，以及一次严重的过敏反应发作，维持剂量时需要3剂肌肉注射肾上腺素。免疫疗法被停用。一次这样的发作后血清类胰蛋白酶水平为29 ng/mL，4周后的基线水平为25 ng/mL。体格检查无异常，包括无皮肤肥大细胞增多症的皮肤病变。由于基线类胰蛋白酶水平升高，进行了骨髓活检，结果显示有肥大细胞的多灶性致密浸润。诊断为系统性肥大细胞增多症。该患者接受了奥马珠单抗治疗，能够耐受免疫疗法，目前维持终身免疫疗法。他在野外再次被蜇伤，未发生过敏反应。
