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

Journal: The Journal of allergy and clinical immunology 2021;148(4):964-983

PMID: 34384610

Full Text on Elsevier Science View on PubMed

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.

Address: Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, Ohio; Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.; Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.; Division of Allergy and Immunology, Department of Internal Medicine, University of Colorado, Aurora, Colo.; Division of Allergy and Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich.; Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.; Division of Allergy and Immunology, Department of Internal Medicine, John Hopkins School of Medicine, Baltimore, Md.; Department of Medicine, the Academy of Medicine of Rio de Janeiro, Rio de Janeiro, Brazil.; Centro de Excelencia en Asma y Alergia, Hospital Médica Sur, Ciudad de México, México.; Asthma and Allergy Center, Lewisville, Tex; Asthma and Allergy Center, Flower Mound, Tex; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Tex.; Division of Gastroenterology, Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah.; Division of Gastroenterology, Hepatology, and Nutrition, Allergy and Asthma Center, McLean, Va.; Division of Allergy and Immunology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.; Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio.; Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio. Electronic address: [email protected].

DOI: 10.1016/j.jaci.2021.06.030

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MeSH Terms: Biopsy, Bone Marrow, Cell Count, Enteritis, Eosinophilia, Eosinophilic Esophagitis, Eosinophils, Gastritis, Gastrointestinal Tract, Humans, Hypereosinophilic Syndrome, Mast Cells, Mastocytosis, Skin