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 mastocytosis, highlighting how treatment needs may differ in this high-risk population.
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 epinephrine, 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 antihistamines 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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