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Review
. 2020 Oct;20(5):431-437.
doi: 10.1097/ACI.0000000000000678.

Hymenoptera venom-induced anaphylaxis and hereditary alpha-tryptasemia

Michael P O'Connell  1 , Jonathan J Lyons
Affiliations
Review

Hymenoptera venom-induced anaphylaxis and hereditary alpha-tryptasemia

Michael P O'Connell et al. Curr Opin Allergy Clin Immunol. 2020 Oct.

Abstract

Purpose of review: To discuss the association between the common dominantly inherited genetic trait hereditary alpha-tryptasemia (HαT) and hymenoptera venom-induced anaphylaxis (HVA).

Recent findings: Elevated BST has been correlated with more severe systemic anaphylaxis in humans in a number of settings - most notably in HVA. Clonal mast cell disease, in particular, systemic mastocytosis, is frequently associated with elevated BST, and is a major risk factor for severe HVA. However, clonal mast cell diseases are believed to be rare, whereas HVA is relatively more common. HαT affects an estimated 3-5% of Western populations and is the common cause for elevated BST in these individuals. An association between HαT and severe HVA, as well as clonal mast cell disease has recently been demonstrated wherein this trait modifies reaction severity in venom allergic individuals. A mechanism underlying this association has been proposed through the identification of naturally occurring heterotetrameric tryptases and characterization of their unique physical attributes.

Summary: Here we discuss the long-standing association between elevated BST and HVA severity, how HαT fits into this landscape, and review the clinical and mechanistic evidence that supports HαT as a modifier of HVA.

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Conflict of interest statement

Conflicts of interest

The authors have no potential conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Scale Venn diagram depicting the measured prevalence of hereditary alpha tryptasemia (HαT), the estimated prevalence of systemic mastocytosis (SM), Hymenoptera venom-induced anaphylaxis (HVA), grade IV (Mueller scale) HVA reactions, and their respective overlap with one another.
See this image and copyright information in PMC

References

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    1. Lyons JJ, Chovanec J, O'Connell MP, Liu Y, Selb J, Zanotti R, et al. Heritable risk for severe anaphylaxis associated with increased α-tryptase-encoding germline copy number at TPSAB1. J Allergy Clin Immunol. 2020;In press.

      Demonstrated for the first time HαT is associated with increased risk of severe HVA and clonal and non-clonal mast cell disorders, potentially resulting from unique activities of α/β-tryptase heterotetramers.

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