A review published in Annals of Allergy, Asthma & Immunology found that reactions to medications, though possible in patients with mast cells disorders such as systemic mastocytosis (SM), may not be as common as many believe.
“While drug-induced reactions, particularly anaphylaxisAnaphylaxis A severe allergic reaction that can turn fatal without treatment. Patients with SM are at a higher risk of developing anaphylaxis., are a major concern, recent data suggest that the overall prevalence of severe reactions is relatively low,” the authors said.
It’s fairly common for patients with SM to avoid taking medication out of fear of experiencing an adverse reaction. Although this is a valid concern, such behavior could prevent an individual from receiving the care that they need.
In their review, the authors explored several classes of drugs to determine which present the highest and lowest risks to patients with SM.
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In one European registry, 8.7% of patients with 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. reported a drug-induced reaction, with 12.5% of patients with 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. experienced a reaction. Another study found that 18.3% of individuals with a 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. disorder reported a drug reaction, with 6.3% experiencing anaphylaxis.
Nonsteroidal anti-inflammatory drugs (NSAIDs), the class of drugs that includes ibuprofen and aspirin, emerged as the most common symptom triggerSymptom trigger The symptoms of SM may become worse when certain triggers activate mast cells. Common symptom triggers in SM include exercise, insect bites, stress, scented products, alcohol and spicy foods., followed by antibiotics. Perioperative drugs, which are given before, during and after surgical procedures, were the third most common trigger.
Local anesthesia and contrast media pose relatively low risks to patients with SM and other forms of mastocytosis, the authors said, though reactions are still possible.
Overall, these findings suggest that individuals with SM can continue to take medications that they have previously tolerated. More care should be taken in patients who are deemed high-risk, though. 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 corticosteroids may reduce the risk of experiencing a drug reaction, but the authors noted more research is needed to confirm this.
“Individualized assessment should be prioritized, relying on a detailed clinical history to guide decisions,” the authors wrote. “A history-driven, evidence-based approach allows the majority of patients with mast cell disorders to be treated effectively without unnecessary drug avoidance.”
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