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He was advised to avoid the typical triggers for mast cell degranulation (which caused the hypotensive episodes and associated symptoms), including alcohol, heat, cold, exertion, emotional upset, narcotics, radiocontrast agents, nonsteroidal anti-inflammatory drugs, acetylsalicylic acid, seafood, Hymenoptera stings, anticholinergic agents, polymyxin B, surgery, and mechanical irritation of his urticaria pigmentosa rash (eg, massage).
Interestingly, elevated serum tryptase levels were found in 10% of patients allergic to Hymenoptera stings, (6) and, recently, cutaneous mastocytosis was documented in 1% of patients allergic to Hymenoptera stings.
Sujatha Ramesh studied 57 cases of Hymenoptera stings and found that local reactions predominated, with just 12 children having systemic symptoms and 2 suffering reactions serious enough to require hospitalization.