A case report recently published in The American Journal of the Medical Sciences illustrates the challenges of addressing insomnia in indolent systemic mastocytosis (SM).
The report described a 72-year-old man who had been diagnosed with indolent SMIndolent SM A subtype of nonadvanced SM caused by the abnormal accumulation of mast cells in the bone marrow and other organs. Indolent SM accounts for around 90% of SM cases. 18 years previously following unusual bee sting reactions. Around the time of his indolent SM diagnosis, he began to experience poor sleep quality.
The patient took antihistaminesAntihistamines Medications that block the effects of histamine, the chemical found in mast cells that is responsible for many of the symptoms of SM, as well as many allergic reactions. for his skin symptoms, as well as montelukast and albuterol for bronchospasms. While his mastocytosisMastocytosis Rare disease caused by the buildup of mast cells. Cutaneous mastocytosis primarily affects the skin and is more common in children, while systemic mastocytosis affects internal organs and is more common in adults. symptoms were well-controlled, as the years went by his insomnia worsened to the point that it negatively affected his quality of life. Treatment with conventional sleep medications did not yield any results.
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Physicians considered that his insomnia might be due to the overproduction of prostaglandin and leukotrienes — substances produced by mast cells that can disrupt sleep — as well as the adverse effects of montelukast. Montelukast is known to cause severe neuropsychiatric complications. As such, the patient’s physicians discontinued his montelukast treatment.
Almost immediately, the patient’s insomnia resolved. The improvement was so notable that he no longer required sleep medications and was able to sleep consistently undisturbed.
Despite being off montelukast, he has not had bronchospasms. If montelukast cessation had not been successful, the patient’s physicians’ alternative plan was cognitive behavioral therapy.
This case report is significant because it highlights how both indolent SM and associated therapies can cause insomnia. Getting the balance right between the treatment of primary side effects and avoiding additional harm is a delicate one. The authors noted that in the case of this patient, it appears that the medications causing persistent insomnia ultimately did more harm than good.
“This case sheds light on the complexities of diagnosing and managing neuropsychiatric symptoms in mast cellMast cell A type of white blood cell produced in the bone marrow. They help defend against infections and play a key role in allergic reactions. In SM, mast cells become overactive and build up throughout the body. disorders,” the authors concluded.
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