Empty mast cell syndrome: fallacy or fact?

Mohamed, Omar E, Baretto, Richard L, Walker, Ian, Melchior, Cathryn, Heslegrave, Jane, Mckenzie, Ruth, Hullur, Chidanand, Ekbote, Anjali and Krishna, Mamidipudi Thirumala (2020) Empty mast cell syndrome: fallacy or fact? Journal of clinical pathology, 73 (5). pp. 250-256. ISSN 1472-4146. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs.

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Official URL: https://jcp.bmj.com/content/73/5/250.long


Post-anaphylaxis mast cell anergy (PAMA), commonly referred to as 'empty mast cell (MC) syndrome', is a state of temporary loss of cutaneous MC reactivity in the immediate aftermath of anaphylaxis. Data relating to this condition are sparse and the incidence rate is currently unknown. PAMA has been described only in a few published case reports in the context of hymenoptera venom allergy and perioperative anaphylaxis. Best practice guidelines regarding optimal timing for performing skin tests postanaphylaxis are largely based on expert opinion, and allergy work-up has been recommended after 4-6 weeks postanaphylaxis to avoid false-negative results.This article provides a review of clinical literature surrounding PAMA, critically evaluates intracellular events in MCs from in vitro data and hypothesises regarding plausible immune mechanisms. There are no published data to directly explain molecular mechanisms underlying this phenomenon. Although not evidence based, PAMA has been attributed to depletion of MC granules following anaphylaxis. It is also plausible that exposure to high allergen concentrations in anaphylaxis can induce a temporary shift in MCs towards dominance of inhibitory signalling pathways, thus contributing to a state of transient hyporesponsiveness observed in some patients. Other potential contributory factors for reduced MC reactivity include downregulation of FcεRI expression, cross-linking of FcεRI to the inhibitory, low-affinity IgG receptors and administration of pharmacotherapeutic agents for anaphylaxis treatment. It is likely that this interesting phenomenon can be explained by a combination of these proposed mechanisms in addition to other genetic/host factors that have not yet been identified.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs.
Subjects: QY Clinical pathology
WD Diseases and disorders of systemic, metabolic or environmental origin > WD300 Hypersensitivity. Allergy
WO Surgery > WO500 Anaesthesia
Divisions: Clinical Support > Anaesthetics
Clinical Support > Immunology
Clinical Support > Infectious Diseases
Clinical Support > Pathology
Related URLs:
Depositing User: Mrs Noomi Tyholdt-Pidgley
Date Deposited: 11 Jun 2020 14:22
Last Modified: 11 Jun 2020 14:22
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3110

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