{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:39:28Z","timestamp":1791362368876,"version":"4.3.1"},"reference-count":62,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Clin Pathol"],"accepted":{"date-parts":[[2019,11,25]]},"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:p>Post-anaphylaxis mast cell anergy (PAMA), commonly referred to as \u2018empty mast cell (MC) syndrome\u2019, is a state of temporary loss of cutaneous MC reactivity in the immediate aftermath of anaphylaxis. Data relating to this condition are sparse and the incidence rate is currently unknown. PAMA has been described only in a few published case reports in the context of hymenoptera venom allergy and perioperative anaphylaxis. Best practice guidelines regarding optimal timing for performing skin tests postanaphylaxis are largely based on expert opinion, and allergy work-up has been recommended after 4\u20136 weeks postanaphylaxis to avoid false-negative results.<\/jats:p>\n                  <jats:p>This article provides a review of clinical literature surrounding PAMA, critically evaluates intracellular events in MCs from in vitro data and hypothesises regarding plausible immune mechanisms. There are no published data to directly explain molecular mechanisms underlying this phenomenon. Although not evidence based, PAMA has been attributed to depletion of MC granules following anaphylaxis. It is also plausible that exposure to high allergen concentrations in anaphylaxis can induce a temporary shift in MCs towards dominance of inhibitory signalling pathways, thus contributing to a state of transient hyporesponsiveness observed in some patients. Other potential contributory factors for reduced MC reactivity include downregulation of Fc\u03b5RI expression, cross-linking of Fc\u03b5RI to the inhibitory, low-affinity IgG receptors and administration of pharmacotherapeutic agents for anaphylaxis treatment. It is likely that this interesting phenomenon can be explained by a combination of these proposed mechanisms in addition to other genetic\/host factors that have not yet been identified.<\/jats:p>","DOI":"10.1136\/jclinpath-2019-206157","type":"journal-article","created":{"date-parts":[[2019,12,12]],"date-time":"2019-12-12T17:15:38Z","timestamp":1576170938000},"page":"250-256","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Empty mast cell syndrome: fallacy or fact?"],"prefix":"10.1136","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9102-278X","authenticated-orcid":false,"given":"Omar E","family":"Mohamed","sequence":"first","affiliation":[{"name":"Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard L","family":"Baretto","sequence":"additional","affiliation":[{"name":"Allergy and 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