Drug-induced anaphylaxis is uncommon in mastocytosis
Published: March 29, 2024
Mastocytosis refers to a rare group of heterogenous disorders characterized by excessive activation and accumulation of mast cells in the skin and/or internal organs. These patients are often susceptible to severe immediate hypersensitivity reactions, namely anaphylaxis, especially to Hymenoptera venom. Thus, it’s hypothesized that the consumption of certain medications could also trigger anaphylactic reactions. This notion has informally led to discouraging patients from using specific drugs, including non-steroidal anti-inflammatory drugs (NSAIDs), X-ray contrast media, and peri-operative drugs. This concern became particularly significant during the recent pandemic when administering COVID-19 vaccines. However, this issue has yet to be systematically explored.
In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice (2024), Beyens et al. systematically investigated the prevalence and severity of drug-induced anaphylaxis (DIA) in a large cohort of patients with mastocytosis. The study included 470 consecutive adult patients from two independent European reference centers. Each patient underwent a comprehensive allergy assessment, which included a wide range of allergy tests, before experienced allergists individually evaluated their self-reported drug hypersensitivity reactions.
The study reveals that drug hypersensitivity was prevalent in 18.3% of the patients, a prevalence similar to that in the general adult population. Moreover, approximately 6% of patients experienced drug-induced anaphylaxis (DIA). Among the triggers, NSAIDs were the most common (56%), followed by perioperative agents (23%) and antibiotics (13%). Anaphylactic reactions were predominantly severe, with hypotensive syncope occurring in 43% of patients. Notably, all these drug-related hypersensitivity incidents took place prior to the diagnosis of mastocytosis.
While the prevalence of DIA in mastocytosis tends to be higher than in the general population, it is much less frequently triggered than by insect venoms. The authors recommend a comprehensive allergy evaluation for mastocytosis patients who have previously reacted to drugs. However, drugs that have been well-tolerated can continue to be used without specific precautions. This study could potentially pave the way for the development of new paradigms that challenge the overly generic advice regarding drug avoidance and premedication in mastocytosis.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
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