BOLETÍN BIBLIOGRÁFICO
DE INMUNOTERAPIA
Artículo destacado – Julio 2019
1
La IgG4 es un biomarcador de efectividad en pacientes con mastocitosis y alergia a venenos.
Venom-immunotherapy in patients with clonal mast cell disorders: IgG4 correlates with protection.
Jarkvist J, Salehi C, Akin C, Gülen T
Allergy. 2019 Jul 15. doi: 10.1111/all.13980. [Epub ahead of print]
BACKGROUND
Patients with clonal mast cell disorders (cMCD); systemic mastocytosis (SM), and monoclonal mast cell activation syndrome (MMAS), represent an increased risk for hymenoptera venom anaphylaxis (HVA). Lifelong venom-immunotherapy (VIT) is recommended; however, its efficacy and safety is controversial. Hence, we sought to evaluate the efficacy and safety of VIT in HVA patients with cMCD.
METHODS
A retrospective study was conducted among 46 patients with Vespula-venom allergy who had experienced severe HVA; 32 cMCD (22 with SM, 10 with MMAS) and 14 controls. There were no differences between cMCD patients and controls in age (58 vs 66) and duration of VIT (47 vs. 48 months), respectively.
RESULTS
During VIT, 11 (34%) cMCD patients experienced adverse reactions (ARs) (7% in controls), including 1 anaphylaxis. There were 23 re-stings in 17 (53%) patients during VIT. Of episodes, four (17%) presented with anaphylaxis, 14 (60%) with local reaction, and 5 (23%) were asymptomatic. In 11 episodes (48%), the patient did not take epinephrine, of these 8 (73%) presented with local reaction, and 3 (27%) were asymptomatic. Patient-based protection from anaphylaxis was 76% (4/17) in cMCD vs. 100% in controls during VIT. The venom-specific IgG4 levels increased during VIT (p <0.001); although tryptase and IgE levels were unaltered.
CONCLUSIONS
Both safety and efficacy of VIT in cMCD patients was slightly reduced than controls. Severe ARs were rare. The elevated IgG4 levels may be a biomarker for efficacy of VIT in cMCD patients, as it correlates with protection from re-stings.