Developing a standardized approach for assessing mast cells and eosinophils on tissue biopsies: A Work Group Report of the AAAAI Allergic Skin Diseases Committee

Nives Zimmermann, J. Pablo Abonia, Stephen C. Dreskin, Cem Akin, Scott Bolton, Corinne S. Happel, Mario Geller, Désirée Larenas-Linnemann, Anil Nanda, Kathryn Peterson, Anita Wasan, Joshua Wechsler, Simin Zhang, Jonathan A. Bernstein*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


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 languageEnglish (US)
Pages (from-to)964-983
Number of pages20
JournalJournal of Allergy and Clinical Immunology
Issue number4
StatePublished - Oct 2021


  • 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


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