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Mastocytosis is a heterogeneous disorder characterized by the proliferation and accumulation of mast cells (MCs) in the skin, bone marrow, and other tissues [1]. Owing to massive MC activation and release of mediators, patients with mastocytosis may experience systemic symptoms, including hypotension and shock, flushing, headache, abdominal pain, and diarrhea. Serum baseline tryptase correlates with the total MC count and burden and is increased in many patients. In mastocytosis, MC can be activated by various stimuli, including hymenoptera venom, through an IgE-mediated mechanism [2]. There are several reports on patients with systemic mastocytosis (SM) and a history of severe sting reactions, but with negative venom-specific IgE and skin test results [3]. In such cases, other diagnostic methods, such as the basophil activation test (BAT), can prove useful [4]. Reports about the usefulness of BAT in patients with negative specific IgE (sIgE) results show varying results. Some studies find that BAT does not provide useful information in this kind of patient [5,6], while other papers report the opposite [7,8]. Interestingly, different methods for identifying basophils were used in the studies, and negative results were obtained in those using chemokine CC receptor type 3 (CCR3) [5,6], whereas positive results were obtained in those using the IL3 receptor (CD123) in conjunction with HLA-DR [7] or CD45 and IgE [8]. We discuss the usefulness of BAT in 2 patients with systemic reactions after wasp sting and mastocytosis. We studied 2 men aged 53 and 64 years (patient 1 and patient 2, respectively) with systemic reactions after wasp sting. Patient 1 presented dizziness, vomiting, dyspnea, and loss of consciousness 25 minutes after the sting, and patient 2 experienced flushing and loss of consciousness 10 minutes after the sting. Neither experienced cutaneous symptoms. Both had high tryptase values (>20 μg/mL) (Table) 1 month after the reactions. is a confounding factor that is overrepresented in ß-lactam– allergic patients and that the previously described associations could have been due to atopy.

The Method for Selecting Basophils Might Be Determinant in the Basophil Activation Test in Patients With Mastocytosis