Open AccessMastocytosis presenting with mast cell‐mediator release‐associated symptoms elicited by cyclo oxygenase inhibitors: prevalence, clinical, and laboratory features
Author(s) -
Rama Tiago Azenha,
Morgado José Mário,
Henriques Ana,
Escribano Luis,
AlvarezTwose Iván,
SanchezMuñoz Laura,
Moreira André,
Romão José,
Órfão Alberto,
Matito Almudena
Publication year - 2022
Publication title -
clinical and translational allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.979
H-Index - 37
ISSN - 2045-7022
DOI - 10.1002/clt2.12132
Subject(s) - medicine , anaphylaxis , systemic mastocytosis , tryptase , cutaneous mastocytosis , mast cell , gastroenterology , epidemiology , prostaglandin d2 , allergy , prostaglandin , immunology , pharmacology
Background Nonsteroidal anti‐inflammatory drugs (NSAIDs) are frequently avoided in mastocytosis, because of a potential increased risk for drug hypersensitivity reactions (DHRs) due to inhibition of cyclo‐oxygenase (COX), subsequent depletion of prostaglandin E 2 and release of leukotrienes. Objectives Here, we aimed at determining the prevalence of mast cell (MC) mediator release symptoms triggered by NSAIDs in mastocytosis patients and the associated clinical and laboratory features of the disease. Methods Medical records from 418 adults to 223 pediatric mastocytosis patients were retrospectively reviewed. Patients were classified according to tolerance patterns to NSAIDs and other COX inhibitors (COXi) and compared for epidemiological, clinical and laboratory findings. Results Overall, 87% of adults and 91% of pediatric patients tolerated NSAIDs and other COXi. Among adult and pediatric patients presenting DHRs, 5% and 0% reacted to multiple NSAIDs, 4% and 0.7% were single reactors, and 3% and 8% were single reactors with known tolerance to paracetamol but unknown tolerance to other COXi, respectively. Among adults, hypersensitivity to ≥2 drugs was more frequent among females ( p = 0.009), patients with prior history of anaphylaxis to triggers other than NSAIDs or other COXi and Hymenoptera venom ( p = 0.009), presence of baseline flushing ( p = 0.02), baseline serum tryptase ≥48 ng/ml ( p = 0.005) and multilineage KIT mutation ( p = 0.02). In contrast, tolerance to NSAIDs and other COXi was more frequent among males ( p = 0.02), in patients with anaphylaxis caused by Hymenoptera venom ( p = 0.02), among individuals who had skin lesions due to mastocytosis ( p = 0.01), and in cases that had no baseline pruritus ( p = 0.006). Based on these parameters, a score model was designed to stratify mastocytosis patients who have never received NSAIDs or other COXi apart from paracetamol, according to their risk of DHR. Conclusions Our results suggest that despite the frequency of MC mediator related symptoms elicited by NSAIDs and other COXi apart from paracetamol is increased among mastocytosis patients versus the general population, it is lower than previously estimated and associated with unique disease features. Patients that tolerated NSAIDs and other COXi following disease onset should keep using them. In turn, adults with unknown tolerance to such drugs and a positive score should be challenged with a preferential/selective COX‐2 inhibitor, while the remaining may be challenged with ibuprofen.