Venom immunotherapy in indolent systemic mastocytosis with high serum tryptase level

Figures & data

Figure 1. (a) Urticaria pigmentosa (back and both arms). (b) Urticaria pigmentosa (abdomen and right arm)

Table 1. Apis mellifera venom immunotherapy (VIT) administration scheme of our case

Day	Time (min)	Dose (μg)	Reaction	Treatment
1	0	0.1	None	None
	30	1	None	None
	60	10	None	None
	90	20	None	None
	150	30	10 min after the injection, the patient experienced burning sensation and itching all over the body, facial erythema was observed, the patient’s BP: 133/56 mmHg, HR: 120 beats/min, and SaO2: 95%.	IV pheniramine maleate 45.5 mg and methylprednisolone 40 mg were administered; 15 min later, vital signs returned to normal, and symptoms disappeared completely.
2	0	20	15 min after the injection, numbness of the face and nasal congestion were observed in the patient, but his vital signs remained stable.	IV pheniramine maleate 45.5 mg was administered, and symptoms improved within 5 min.
	60	15	None	None
	120	20	None	None
	180	30	5 min after the injection, the patient experienced dyspnea, chest pain, loss of consciousness, and urine and fecal incontinence; the patient’s BP: 90/40 mmHg, HR: 150 beats/min, and SaO2: 91%.	IM adrenaline 0.5 mg, IV pheniramine maleate 45.5 mg, methylprednisolone 40 mg, saline infusion, and oxygen therapy were administered; 5 min later, the patient’s BP:76/38 mmHg, HR: 155 beats/min, SaO2: 80%, IM adrenaline 0.5 mg was administered again; 3–4 min later, symptoms disappeared, and BP: 101/48 mmHg, HR: 105 beats/min, SaO2: 95%, and the VIT protocol was terminated.

BP: blood pressure, HR: heart rate, SaO₂: oxygen saturation, IV: intravenous, IM: intramuscular.