Patients with systemic mastocytosis (SM) are at risk of drug-induced allergic reactions, a point for doctors to consider when administering treatment, according to a study recently published in Asthma Allergy Immunology.
When patients with SM experience allergic reactions, they tend to be more severe than typically expected among the general population. One of the more common triggers of anaphylaxisAnaphylaxis A severe allergic reaction that can turn fatal without treatment. Patients with SM are at a higher risk of developing anaphylaxis. in SM are therapeutic agents.
Among the therapeutic agents most commonly associated with allergic reactions in SM are nonsteroidal inflammatory drugs (NSAIDs), antibiotics and opioid painkillers. A European study found that the prevalence of hypersensitivity reactions (an exaggerated immune response, of which allergies are a part) associated with NSAIDs was 11.3%. A 15-year study involving 239 patients with SM found that 14.2% of patients had hypersensitivity reactions associated with antibiotics.
In advanced SMAdvanced SM In these subtypes of SM, mast cells begin to damage organs. Advanced SM includes the subtypes aggressive SM, mast cell leukemia and SM with an associated hematological neoplasm., the most common cause of drug-induced hypersensitivity reactions is the administration of NSAIDs and antibiotics of the penicillin group.
Read more about SM testing and diagnosis
Studies show that immunoglobulin E (IgE) receptors are found on the surface of mast cells. Some drugs may trigger mast cell activationMast cell activation Describes when mast cells release histamine and other mediators into the blood stream in response to an allergen or other trigger. This leads to symptoms like fatigue, rash and, in severe cases, anaphylaxis. associated with IgE via drug-specific IgE antibodies. In addition, studies show that Mas-related G protein-coupled receptor X2 (MRGPRX2), another receptor expressed by mast cells, plays a role in triggering allergic reactions unassociated with IgE.
The management of drug-induced hypersensitivity reactions remains complex. This is because the drugs that cause these reactions are often deemed necessary in the first place, and doctors cannot be sure that they will cause hypersensitivity reactions until they occur. However, if doctors avoid prescribing medications that may potentially cause hypersensitivity reactions, this may also cause harm, especially in clinical situations that urgently require intervention.
“Accurate identification and classification of hypersensitivity reactions is extremely important both to minimize the risk of anaphylaxis and to prevent unnecessary drug restrictions for these patients,” the authors of the study concluded. “Premedication strategies are recommended especially in high-risk individuals, and patients with a history of adverse reactions should undergo a comprehensive allergy evaluation.”
Sign up here to get the latest news, perspectives, and information about SM sent directly to your inbox. Registration is free and only takes a minute.
