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Drug allergy in mast cell disease

Brockow, Knut; Bonadonna, Patrizia

Current Opinion in Allergy & Clinical Immunology: August 2012 - Volume 12 - Issue 4 - p 354–360
doi: 10.1097/ACI.0b013e328355b7cb
DRUG ALLERGY: Edited by Bernard Thong and Miguel Blanca

Purpose of review: Mastocytosis in adults is associated with a history of anaphylaxis in 22–49%. In addition, monoclonal mast cell activation syndrome has been described presenting with anaphylaxis, especially in patients with hymenoptera venom anaphylaxis. Data on patients with drug hypersensitivity and mast cell diseases are scarce.

Recent findings: Drugs are elicitors of anaphylaxis in patients with mastocytosis. Drug hypersensitivity is only seldom described as associated with undetected mast cell disease in the literature. Together with a single-centred retrospective study, this data suggests that from all patients with drug-induced anaphylaxis, probably only a minority are associated with mast cell disease. Most of these cases in the literature are related to general anaesthesia. Thus, for patients with mastocytosis, general anaesthesia appears to be a procedure associated with risk of mast cell degranulation, and special precautions should be considered.

Summary: The association between immediate drug hypersensitivity and undetected mast cell diseases appears to be moderate, but nevertheless basal serum tryptase determination and examination for skin signs of mast cell disorders are recommended. An ongoing European multicenter study by the European Network for Drug Allergy will provide more information on this topic.

aDepartment of Dermatology and Allergology, Technische Universität Munich, and Center for Allergy and Environment, Technische Universität und Helmholtz Center Munich, Munich, Germany

bAllergy Unit, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

Correspondence to Knut Brockow, Department of Dermatology and Allergology Biederstein, Technische Universität Munich, Biedersteiner Strasse 29, D-80802, Munich, Germany. Tel: +4989 4140 3182; e-mail: knut.brockow@lrz.tum.de

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.