Abstract
Mast cells and eosinophils are commonly found, expectedly or unexpectedly, in human tissue biopsies. Although the clinical significance of their presence, absence, quantity, and quality continues to be investigated in homeostasis and disease, there are currently gaps in knowledge related to what constitutes quantitatively relevant increases in mast cell and eosinophil number in tissue specimens for several clinical conditions. Diagnostically relevant thresholds of mast cell and eosinophil numbers have been proposed and generally accepted by the medical community for a few conditions, such as systemic mastocytosis and eosinophilic esophagitis. However, for other mast cell– and eosinophil-associated disorders, broad discrepancies remain regarding diagnostic thresholds and how samples are processed, routinely and/or specially stained, and interpreted and/or reported by pathologists. These discrepancies can obfuscate or delay a patient's correct diagnosis. Therefore, a work group was assembled to review the literature and develop a standardized consensus for assessing the presence of mast cells and eosinophils for a spectrum of clinical conditions, including systemic mastocytosis and cutaneous mastocytosis, mast cell activation syndrome, eosinophilic esophagitis, eosinophilic gastritis/enteritis, and hypereosinophilia/hypereosinophilic syndrome. The intent of this work group is to build a consensus among pathology, allergy, dermatology, hematology/oncology, and gastroenterology stakeholders for qualitatively and quantitatively assessing mast cells and eosinophils in skin, gastrointestinal, and bone marrow pathologic specimens for the benefit of clinical practice and patients.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 964-983 |
| Number of pages | 20 |
| Journal | Journal of Allergy and Clinical Immunology |
| Volume | 148 |
| Issue number | 4 |
| DOIs | |
| State | Published - Oct 2021 |
Funding
We thank Shawna Hottinger (Cincinnati Children's Hospital Medical Center) for critical review and edits to the manuscript. We thank Christopher Woods (Cincinnati Children's Hospital Medical Center) for assistant with figures. Disclosure of potential conflict of interest: PA has received grants from the National Institutes of Health (NIH)/National Institute of Allergy and Infectious Diseases (U54 AI117804 and R01 AI124355-01), the Patient-Centered Outcomes Research Institute (SC14-1403-11593), and Shire/Takeda. SCD has received grant support from the NIH and Genentech, Inc; is a member of the Medical Expert Panel, Department of Health and Human Services, and Division of Vaccine Injury Compensation; and serves on an advisory board and/or is a consultant for Allakos, CSL Behring, BioCryst, Grifols, and Ukko. CA has received research grant support from Blueprint Medicines and is a consultant for Blueprint Medicine and Novartis. DL-L has received personal fees from Allakos, Amstrong, AstraZeneca, DBV Technologies, Grunenthal, GlaxoSmithKline, MEDA, Mylan, Menarini, Merck Sharp and Dohme, Novartis, Pfizer, Sanofi, Siegfried, UCB, and Gossamer; and grants from Sanofi, AstraZeneca, Novartis, UCB, GlaxoSmithKline, Teva, and the Purina Institute. KP has received equity in Nexeos; research support from AstraZeneca, Ellodi, Sanofi- Regeneron, and Adare; independent grants from the NIH, Chobani, and Allakos; and consulting/advisory board fees from Alladapt, Eli Lily, Medscape, Ellodi, and Takeda. JBW has received consulting fees for medical advisory boards for Allakos and Regeneron. JAB is a consultant principal investigator for Blueprint Medicine, Celldex, Allakos, AstraZeneca, Sanofi-Regeneron, Novartis, Genentech, Shire/Takeda, CSL Behring, Pharming, Biomarin, Kalvista, Ionis, and Merck; and speaker for GlaxoSmithKline, Sanofi-Regeneron, AstraZeneca, Novartis, Genentech, Pharming, Optinose, CSL Behring, and Shire/Takeda. The rest of the authors declare that they have no relevant conflicts of interest. Disclosure of potential conflict of interest: PA has received grants from the National Institutes of Health (NIH)/National Institute of Allergy and Infectious Diseases (U54 AI117804 and R01 AI124355-01), the Patient-Centered Outcomes Research Institute (SC14-1403-11593), and Shire/Takeda. SCD has received grant support from the NIH and Genentech, Inc; is a member of the Medical Expert Panel, Department of Health and Human Services, and Division of Vaccine Injury Compensation; and serves on an advisory board and/or is a consultant for Allakos, CSL Behring, BioCryst, Grifols, and Ukko. CA has received research grant support from Blueprint Medicines and is a consultant for Blueprint Medicine and Novartis. DL-L has received personal fees from Allakos, Amstrong, AstraZeneca, DBV Technologies, Grunenthal, GlaxoSmithKline, MEDA, Mylan, Menarini, Merck Sharp and Dohme, Novartis, Pfizer, Sanofi, Siegfried, UCB, and Gossamer; and grants from Sanofi, AstraZeneca, Novartis, UCB, GlaxoSmithKline, Teva, and the Purina Institute. KP has received equity in Nexeos; research support from AstraZeneca, Ellodi, Sanofi- Regeneron, and Adare; independent grants from the NIH, Chobani, and Allakos; and consulting/advisory board fees from Alladapt, Eli Lily, Medscape, Ellodi, and Takeda. JBW has received consulting fees for medical advisory boards for Allakos and Regeneron. JAB is a consultant principal investigator for Blueprint Medicine, Celldex, Allakos, AstraZeneca, Sanofi-Regeneron, Novartis, Genentech, Shire/Takeda, CSL Behring, Pharming, Biomarin, Kalvista, Ionis, and Merck; and speaker for GlaxoSmithKline, Sanofi-Regeneron, AstraZeneca, Novartis, Genentech, Pharming, Optinose, CSL Behring, and Shire/Takeda. The rest of the authors declare that they have no relevant conflicts of interest.
Keywords
- Systemic mastocytosis
- allergy
- biopsy
- bone marrow
- consensus
- cutaneous mastocytosis
- dermatology
- eosinophils
- gastroenterology
- gastrointestinal tract
- mast cells
- pathology
- skin
- work group
ASJC Scopus subject areas
- Immunology and Allergy
- Immunology
