Hymenoptera-induced allergy (HVA) is a frequent and sometimes deadly cause of anaphylaxis. In around 7% of adult patients, it is linked with systemic mastocytosis. Systemic mastocytosis is a disease in which hematopoietic mast cell progenitors proliferate. There is new information on the link between systemic mastocytosis and HVA. Hymenoptera venoms are the most prevalent immunoglobulin E-mediated anaphylaxis elicitors in mastocytosis patients. Some patients with systemic mastocytosis do not have cutaneous involvement and were only diagnosed due to HVA. In comparison with individuals with mastocytosis with skin lesions, these patients show unique demographic, clinical, and laboratory properties. They exhibit male predominance, greater than cutaneous symptoms, lower baseline serum tryptase, less bone marrow mast cell aggregations and mast cell lineage-restricted mutations of KIT.

Although hymenoptera-induced anaphylaxis is not primarily a hematological diseases based on mast cells, the latter is present in a large proportion of patients and must be excluded in the peripheral or bone marrow test by basal serum tryptase determination, skin inspection and systemic mastocytosis exclusion.

Reference: https://journals.lww.com/co-allergy/Abstract/2017/10000/Hymenoptera_induced_anaphylaxis__is_it_a_mast_cell.8.aspx