Drugs and Vaccines Hypersensitivity in Children with Mastocytosis

Abstract

Mastocytosis, a heterogeneous mastcell disease, include three different entities: cutaneous mastocytosis, systemic mastocytosis (SM) and mast-cell sarcoma. Tryptase levels can differentiate cutaneous mastocytosis from SM. In mastocytosis, quick onset drug hypersensitivity reactions (DHRs) that are facilitated by mastcell mediators, are investigated in adults. Due to the limited number of children with mastcell disease and increased serum tryptase levels, the role of drugs in this age group is less studied. In this review, we critically assessed relevant papers related with immediate DHRs in children with mastocytosis and discuss practical issues of the management. In childhood mastocytosis, anaphylaxis is frequently idiopathic, and elevated level of basal tryptase, and high burden of disease may increase the risk. Among drugs, antibiotics, NSAIDs and opioids can potentially induce anaphylaxis, anyway avoidance should be recommended only in case of previous reactions. Moreover, vaccinations are not contraindicated in patients with mastocytosis. The risk of severe systemic reactions after drugs intake seems to be extremely low and in general lower in children than in adults. Anyway, studies on this topic especially focusing on children, are missing to state final recommendations.

Drug-Induced Anaphylaxis in Children

“…Physical or mechanical factors are at least equally significant in provoking mast cell degranulation during anesthesia. Because anaphylaxis in children with mastocytosis is most commonly idiopathic, the role of drugs is overestimated [ 62 ]. Some studies have reported a higher risk of DIA in children with systemic illnesses, most often malignancies, storage diseases, cardiovascular diseases, seizure disorders, renal diseases, coagulation abnormalities, and rheumatologic diseases, and/or taking other medications [ 56 ].…”

Serum tryptase and drug hypersensitivity: why, how and what? A systematic review

“…Conflicting results were reported as to whether bST by itself, or as a correlate of mastocytosis or other mast cell related conditions, is a predictor of systemic reactions including drug hypersensitivity [30 ▪▪ ,31,32]. Few pediatric series are available, and systemic mastocytosis is less frequent than cutaneous mastocytosis; however, a recent study reported a lack of association between high bST levels and the occurrence of drug hypersensitivity reactions among children with mastocytosis [33]. Also in a pediatric case, transient increase in aST over bST was reported following the NSAID diclofenac administration as a suppository [34].…”

Changing patterns in the epidemiology of drug allergy

“…DA to quinolones, vancomycin, aminoglycosides, and tetracyclines are rare except in children with cystic fibrosis and chronic diseases with repeated antibiotic exposures 23,172 . Less than 20% of children with a reported history of NSAIDs hypersensitivity had the diagnosis confirmed through challenge 23,100,172,174–177 …”

“…General anesthesia agents and opioid analgesics are a significant cause of DA in hospitalized children and children who had undergone a general anesthesia had more than six times the risk of developing an adverse drug reaction 100,177 …”

“…23,172 Less than 20% of children with a reported history of NSAIDs hypersensitivity had the diagnosis confirmed through challenge. 23,100,172,[174][175][176][177] General anesthesia agents and opioid analgesics are a significant cause of DA in hospitalized children and children who had undergone a general anesthesia had more than six times the risk of developing an adverse drug reaction. 100,177…”