A case report published in the American Journal of Case Reports describes the intensive care management of a severe anaphylactic episode in a patient with suspected 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., highlighting how treatment needs may differ in this high-risk population.
AnaphylaxisAnaphylaxis A severe allergic reaction that can turn fatal without treatment. Patients with SM are at a higher risk of developing anaphylaxis. is a life-threatening systemic hypersensitivity reaction, and the presence of systemic mastocytosis (SM) is known to increase the risk of particularly severe episodes.
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The report details the case of a 31-year-old woman who developed anaphylactic shock after a hornet sting. The reaction rapidly progressed to cardio-respiratory failure, requiring mechanical ventilation and circulatory support.
Doctors initially treated the reaction using standard emergency steps, including injections of epinephrineEpinephrine Also called adrenaline, this hormone is used in emergency situations to reverse symptoms during a severe allergic reaction (anaphylaxis)., the first-line treatment for anaphylaxis. However, the woman had an insufficient response, prompting the need for continuous intravenous (IV) infusion of epinephrine. Additionally, she was treated with large amounts of IV fluids to stabilize her blood pressure, along with 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. and steroids to stabilize the immune response. Doctors also corrected acid-base imbalances that developed as her organs struggled to maintain normal function during the crisis.
The woman improved rapidly with intensive care and was discharged from the intensive care unit in good condition on the third day of hospitalization.
The authors emphasize that although the core management of anaphylaxis in mastocytosis generally mirrors standard treatment guidelines, important differences must be considered. Individuals with mastocytosis may require significantly higher doses of adrenaline, with potential need for continuous IV epinephrine infusion during the first 24 to 48 hours in severe cases.
The report also notes that excessive immune activation in mastocytosis can lead to more severe disturbances in organ perfusion, increasing the risk of metabolic acidosis. In such cases, IV sodium bicarbonate may be required as part of supportive treatment.
The authors said that early admission to intensive care should be strongly considered for patients with mastocytosis who experience anaphylaxis, given the potential for rapid deterioration and reduced responsiveness to first-line therapies.
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