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Review
. 2024 Jan 5;14(2):123.
doi: 10.3390/diagnostics14020123.

Challenges in Drug and Hymenoptera Venom Hypersensitivity Diagnosis and Management in Mastocytosis

Matthew P Giannetti  1   2 , Jennifer Nicoloro-SantaBarbara  2   3 , Grace Godwin  1 , Julia Middlesworth  1 , Andrew Espeland  1 , Julia L Douvas  1 , Mariana C Castells  1   2
Affiliations
Review

Challenges in Drug and Hymenoptera Venom Hypersensitivity Diagnosis and Management in Mastocytosis

Matthew P Giannetti et al. Diagnostics (Basel). .

Abstract

Mastocytosis is a myeloproliferative neoplasm characterized by abnormal proliferation and activation of clonal mast cells typically bearing the KITD816V mutation. Symptoms manifest due to the release of bioactive mediators and the tissue infiltration by neoplastic mast cells. Mast cell activation symptoms include flushing, pruritus, urticaria, abdominal cramping, diarrhea, wheezing, neuropsychiatric symptoms, and anaphylaxis. Up to 50% of patients with mastocytosis report a history of provoked and unprovoked anaphylaxis, with Hymenoptera venom and drugs the most common culprits. NSAIDs, antibiotics, vaccines, perioperative medications, and radiocontrast media are often empirically avoided without evidence of reactions, depriving patients of needed medications and placing them at risk for unfavorable outcomes. The purpose of this review is to highlight the most common agents responsible for adverse drug reactions in patients with mastocytosis, with a review of current epidemiology, diagnosis, and management of drug hypersensitivity and Hymenoptera venom allergy.

Keywords: antibiotics; mast cell; mastocytosis; nonsteroidal anti-inflammatory drugs (NSAIDs); perioperative anaphylaxis; vaccines.

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Conflict of interest statement

Matthew P. Giannetti receives funding from Blueprint medicines, Cogent biosciences, and Inmagene. Mariana C. Castells receives funding from Blueprint medicines and Cogent Biosciences. Jennifer Nicoloro-SantaBarbara receives funding from Cogent biosciences.

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