Histamine Liberation by Codeine and Polymyxin B in Urticaria Pigmentosa

Abstract

Urticaria pigmentosa, a cutaneous form of mastocytosis, is associated with the excretion of above normal amounts of histamine in the urine.^1,2It is estimated that approximately one-third of patients with this condition experience spontaneous attacks of flushing of the skin,¹and it is thought that this flushing is due to release of histamine from the mast cells. If this is true, the administration of a histamine liberator to these patients should produce flushing, and repeated administration of such an agent might maintain the mast cells in a state of histamine depletion, thus preventing further flushing attacks and whealing of the local lesions. Codeine³and polymyxin B^4,5are 2 potent histamine liberators, the latter being particularly specific for histamine. This paper reports observations on the effects of these 2 agents administered to 5 patients with mastocytosis. Total urinary histamine excretion was measured in one case. In this