[A shock reaction from insect bites in patients with urticaria pigmentosa]

The examination of 11 urticaria pigmentosa (UP) patients included allergological history, skin prick, scarification tests and intracutaneous tests with noninfectious and bee poison allergens, total and specific serum IgE measurements, in vitro reaction of histamine release from peripheral blood basophils induced by bee poison. The response of mastocytosis patients to insect sting was characterized by a rapid (within 5 min) development of severe systemic reactions or shock. The skin reactions and serum antibodies to bee poison were not registered in 9 of 11 patients. They also had a negative reaction of allergen-specific histamine release from basophils. This gives evidence for nonimmunological, pseudoallergic mechanism of the shock reaction. The latter can be prevented by bee poison immunotherapy. IgE-antibody-mediated allergic reaction to bee sting could not be excluded in 2 patients. For them specific immunotherapy with bee poison, possibly with purified poison preparations containing the allergens alone, are indicated.