CHILDHOOD MASTOCYTOSIS NEW DEVELOPMENTS IN DIAGNOSIS AND TREATMENT

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CHILDHOOD MASTOCYTOSIS AND VENOM ALLERGY

İdil Akay Hacı1
İlke Taşkırdı2

1İzmir City Hospital, Department of Pediatric Immunology and Allergy, İzmir, Türkiye
2İzmir Katip Çelebi University, Faculty of Medicine, Department of Pediatric Immunology and Allergy, İzmir, Türkiye

Akay Hacı İ, Taşkırdı İ. Childhood Mastocytosis and Venom Allergy. In: Özdemir Ö, editor. Childhood Mastocytosis: New Developments in Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.171-184.

ABSTRACT

Systemic reactions in mastocytosis can be triggered by various factors that differ across age groups. In adults with systemic mastocytosis, Hymenoptera stings are the most common identifiable triggers of anaphylaxis. In contrast, venom plays a less significant clinical role in childhood when the cutaneous form of mastocytosis is more prevalent. On the other hand, Hymenoptera stings, however, can lead to severe and potentially fatal anaphylaxis in individuals with mastocytosis. Although Hymenoptera-in- duced anaphylaxis can occur in all forms of mastocytosis, the risk is highest in those with indolent systemic mastocytosis, elevated IgE levels, and the absence of cutaneous lesions. Anaphylaxis caused by Hymenoptera stings in mastocytosis exhibits distinct clinical characteristics, predominantly in- volving cardiovascular vasodilatory symptoms such as dizziness, hypotension, and loss of conscious- ness, often without accompanying skin manifestations. While research on pediatric patients in this area remains limited, identifying clonal mast cell disease is crucial as it significantly impacts the management of Hymenoptera venom allergy. Preventing future fatal allergic reactions in mastocytosis patients who have experienced a systemic reaction relies on a proper emergency action plan, accurate diagnosis, the prescription of epinephrine auto-injectors, and the administration of highly effective lifelong specific venom immunotherapy. In this chapter, we evaluate the effect of mastocytosis on the diagnosis, treatment, and therapeutic management of venom allergy, as well as future directions in childhood based on recent literature, and we provide current approaches.

Keywords: Anaphylaxis; Child; Immunotherapy; Mastocytosis; Venom

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