Anaphylaxis in patients with mastocytosis: a study on history, clinical features and risk factors in 120 patients

TLDR

Excessive mast cell mediator release may lead to anaphylaxis in patients with mastocytosis, but the incidence, clinical features, and trigger factors have not yet been analyzed. The study aimed to identify risk factors for anaphylaxis in mastocytosis by assessing incidence, severity, clinical characteristics, and triggers in 120 patients and correlating them with disease severity, skin involvement, tryptase, and diaminooxidase levels. The authors evaluated 120 consecutive mastocytosis patients, measuring anaphylaxis incidence, severity, clinical features, and triggers, and correlated these with disease severity, skin involvement, tryptase, and diaminooxidase levels. Adults with mastocytosis had a 49 % anaphylaxis incidence versus 9 % in children, with systemic disease and absence of urticaria pigmentosa lesions linked to higher risk; 48 % of adult reactions were severe, 38 % caused unconsciousness, common triggers were hymenoptera stings, foods, and medication, and patients with anaphylaxis had markedly higher basal tryptase levels, prompting a recommendation for an epinephrine emergency kit.

Abstract

Excessive mast cell mediator release may lead to anaphylaxis in patients with mastocytosis. However, the incidence, clinical features and trigger factors have not yet been analyzed.To identify risk factors for anaphylaxis in mastocytosis, we determined cumulative incidence, severity, clinical characteristics, and trigger factors for anaphylaxis in 120 consecutive patients (53 male; 67 female, median age and range 24 years, 1 month to 73 years), and correlated these with disease severity of mastocytosis, skin involvement, basal total serum tryptase, and diaminooxidase concentrations.The cumulative incidence of anaphylaxis in patients with mastocytosis was higher in adults (49%; P < 0.01) compared with that in children (9%). Only children with extensive skin involvement had experienced anaphylaxis. In adults, anaphylaxis was correlated to the absence of urticaria pigmentosa lesions (P < 0.03). Reactions occurred more frequently in adults with systemic (56%) when compared with cutaneous mastocytosis (13%; P < 0.02). In adults, 48% of reactions were severe, and 38% resulted in unconsciousness. Major perceived trigger factors for adults were hymenoptera stings (19%), foods (16%), and medication (9%); however, in 26% of reactions, only a combination of different triggers preceded anaphylaxis. Trigger factors remained unidentified in 67% of reactions in children compared with 13% in adults. Patients with anaphylaxis had higher basal tryptase values (60.2 +/- 55 ng/ml, P < 0.0001) in comparison with those without (21.2 +/- 33 ng/ml), but not diaminooxidase levels.Adult patients and children with extensive skin disease with mastocytosis have an increased risk to develop severe anaphylaxis; thus, an emergency set of medication including epinephrine is recommended.