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J Allergy Clin Immunol Pract. 2013 Sep-Oct;1(5):474-8. doi: 10.1016/j.jaip.2013.06.014. Epub 2013 Aug 30.

Venom immunotherapy in patients with clonal mast cell disorders: efficacy, safety, and practical considerations.

Author information

  • 1Allergy Unit, Azienda Ospedale Universit√† di Verona, Verona, Italy.
  • 2Allergy Unit, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • 3Haematology Section, Department of Clinical and Experimental Medicine, University of Verona, Italy.
  • 4Allergy and Respiratory Diseases, IRCCS San Martino IST, University of Genoa, Genoa, Italy.
  • 5Centro de Estudios de Mastocitosis de Castilla la Mancha, Hospital Virgen del Valle, Toledo, Spain.
  • 6Allergy Unit, Hospital Universitario de Guadalajara, Guadalajara, Spain.
  • 7Allergy and Respiratory Diseases, IRCCS San Martino IST, University of Genoa, Genoa, Italy. Electronic address:



A preferential association between systemic mastocytosis (SM) and hymenoptera allergy (HVA) has been observed. Patients with both diseases are at risk for more severe reactions, and venom immunotherapy (VIT) may represent a life-saving treatment, but the use of VIT in such patients raised concerns about its safety.


We evaluated a large population of patients with SM and HVA who received VIT.


This prospective study was performed in Italy and Spain. A diagnosis of SM and HVA and a VIT prescription were made according to international recommendations. The patients were carefully followed up during VIT, with special attention to field stings.


A total of 84 patients (70 men, 14 women; mean age 52.1 years) were included, 81% with grade IV reaction, 91% with indolent SM. No difference was seen between the Italian and Spanish patients. There were 10 adverse reactions during the induction phase: 3 with the conventional induction and 7 with the rush-modified induction, none resulted in epinephrine administration and/or hospitalization. Fifty patients had one or more field re-sting (95 episodes), none during induction. The time elapsed from starting VIT and first re-sting was 2 months to 7 years, and the number of re-stings per patient was 1-6. Of the 50 patients who were re-stung, 43 (86%) resulted in being fully protected. Seven patients had reactions, and the maintenance dose was safely increased to 200 mcg. The maintenance dose interval was not different between patients with and those without reactions at re-stings.


VIT is well tolerated, safe, and effective in patients with SM.

Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.


Efficacy; Hymenoptera allergy; Safety; Systemic mastocytosis; Venom immunotherapy

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