Mastocytosis presenting with mast cell‐mediator release‐associated symptoms elicited by cyclo oxygenase inhibitors: prevalence, clinical, and laboratory features
Abstract 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 E2 and release of leukotrienes....
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-03-01
|
| Series: | Clinical and Translational Allergy |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/clt2.12132 |
| _version_ | 1811332654161723392 |
|---|---|
| author | Tiago Azenha Rama José Mário Morgado Ana Henriques Luis Escribano Iván Alvarez‐Twose Laura Sanchez‐Muñoz André Moreira José Romão Alberto Órfão Almudena Matito |
| author_facet | Tiago Azenha Rama José Mário Morgado Ana Henriques Luis Escribano Iván Alvarez‐Twose Laura Sanchez‐Muñoz André Moreira José Romão Alberto Órfão Almudena Matito |
| author_sort | Tiago Azenha Rama |
| collection | DOAJ |
| description | Abstract 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 E2 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. |
| first_indexed | 2024-04-13T16:40:19Z |
| format | Article |
| id | doaj.art-b3b1613331b74f13ab1fa9537da26fc4 |
| institution | Directory Open Access Journal |
| issn | 2045-7022 |
| language | English |
| last_indexed | 2024-04-13T16:40:19Z |
| publishDate | 2022-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical and Translational Allergy |
| spelling | doaj.art-b3b1613331b74f13ab1fa9537da26fc42022-12-22T02:39:16ZengWileyClinical and Translational Allergy2045-70222022-03-01123n/an/a10.1002/clt2.12132Mastocytosis presenting with mast cell‐mediator release‐associated symptoms elicited by cyclo oxygenase inhibitors: prevalence, clinical, and laboratory featuresTiago Azenha Rama0José Mário Morgado1Ana Henriques2Luis Escribano3Iván Alvarez‐Twose4Laura Sanchez‐Muñoz5André Moreira6José Romão7Alberto Órfão8Almudena Matito9Serviço de Imunoalergologia Centro Hospitalar Universitário São João Porto PortugalInstituto de Estudios de Mastocitosis de Castilla La Mancha and CIBERONC CB16/12/00400 Hospital Virgen del Valle Toledo SpainInstituto de Estudios de Mastocitosis de Castilla La Mancha and CIBERONC CB16/12/00400 Hospital Virgen del Valle Toledo SpainSpanish Network on Mastocytosis (REMA) Toledo and Salamanca SpainInstituto de Estudios de Mastocitosis de Castilla La Mancha and CIBERONC CB16/12/00400 Hospital Virgen del Valle Toledo SpainInstituto de Estudios de Mastocitosis de Castilla La Mancha and CIBERONC CB16/12/00400 Hospital Virgen del Valle Toledo SpainServiço de Imunoalergologia Centro Hospitalar Universitário São João Porto PortugalInstituto de Ciências Biomédicas de Abel Salazar Porto PortugalSpanish Network on Mastocytosis (REMA) Toledo and Salamanca SpainInstituto de Estudios de Mastocitosis de Castilla La Mancha and CIBERONC CB16/12/00400 Hospital Virgen del Valle Toledo SpainAbstract 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 E2 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.https://doi.org/10.1002/clt2.12132anaphylaxismast cell‐mediator release‐associated symptomsmast cellsmastocytosisnon‐steroidal anti‐inflammatory drug hypersensitivity |
| spellingShingle | Tiago Azenha Rama José Mário Morgado Ana Henriques Luis Escribano Iván Alvarez‐Twose Laura Sanchez‐Muñoz André Moreira José Romão Alberto Órfão Almudena Matito Mastocytosis presenting with mast cell‐mediator release‐associated symptoms elicited by cyclo oxygenase inhibitors: prevalence, clinical, and laboratory features Clinical and Translational Allergy anaphylaxis mast cell‐mediator release‐associated symptoms mast cells mastocytosis non‐steroidal anti‐inflammatory drug hypersensitivity |
| title | Mastocytosis presenting with mast cell‐mediator release‐associated symptoms elicited by cyclo oxygenase inhibitors: prevalence, clinical, and laboratory features |
| title_full | Mastocytosis presenting with mast cell‐mediator release‐associated symptoms elicited by cyclo oxygenase inhibitors: prevalence, clinical, and laboratory features |
| title_fullStr | Mastocytosis presenting with mast cell‐mediator release‐associated symptoms elicited by cyclo oxygenase inhibitors: prevalence, clinical, and laboratory features |
| title_full_unstemmed | Mastocytosis presenting with mast cell‐mediator release‐associated symptoms elicited by cyclo oxygenase inhibitors: prevalence, clinical, and laboratory features |
| title_short | Mastocytosis presenting with mast cell‐mediator release‐associated symptoms elicited by cyclo oxygenase inhibitors: prevalence, clinical, and laboratory features |
| title_sort | mastocytosis presenting with mast cell mediator release associated symptoms elicited by cyclo oxygenase inhibitors prevalence clinical and laboratory features |
| topic | anaphylaxis mast cell‐mediator release‐associated symptoms mast cells mastocytosis non‐steroidal anti‐inflammatory drug hypersensitivity |
| url | https://doi.org/10.1002/clt2.12132 |
| work_keys_str_mv | AT tiagoazenharama mastocytosispresentingwithmastcellmediatorreleaseassociatedsymptomselicitedbycyclooxygenaseinhibitorsprevalenceclinicalandlaboratoryfeatures AT josemariomorgado mastocytosispresentingwithmastcellmediatorreleaseassociatedsymptomselicitedbycyclooxygenaseinhibitorsprevalenceclinicalandlaboratoryfeatures AT anahenriques mastocytosispresentingwithmastcellmediatorreleaseassociatedsymptomselicitedbycyclooxygenaseinhibitorsprevalenceclinicalandlaboratoryfeatures AT luisescribano mastocytosispresentingwithmastcellmediatorreleaseassociatedsymptomselicitedbycyclooxygenaseinhibitorsprevalenceclinicalandlaboratoryfeatures AT ivanalvareztwose mastocytosispresentingwithmastcellmediatorreleaseassociatedsymptomselicitedbycyclooxygenaseinhibitorsprevalenceclinicalandlaboratoryfeatures AT laurasanchezmunoz mastocytosispresentingwithmastcellmediatorreleaseassociatedsymptomselicitedbycyclooxygenaseinhibitorsprevalenceclinicalandlaboratoryfeatures AT andremoreira mastocytosispresentingwithmastcellmediatorreleaseassociatedsymptomselicitedbycyclooxygenaseinhibitorsprevalenceclinicalandlaboratoryfeatures AT joseromao mastocytosispresentingwithmastcellmediatorreleaseassociatedsymptomselicitedbycyclooxygenaseinhibitorsprevalenceclinicalandlaboratoryfeatures AT albertoorfao mastocytosispresentingwithmastcellmediatorreleaseassociatedsymptomselicitedbycyclooxygenaseinhibitorsprevalenceclinicalandlaboratoryfeatures AT almudenamatito mastocytosispresentingwithmastcellmediatorreleaseassociatedsymptomselicitedbycyclooxygenaseinhibitorsprevalenceclinicalandlaboratoryfeatures |