Triggers of Anaphylaxis in Mastocytosis Patients: Evidence of the Current Drug-Avoidance Recommendation

Detalhes bibliográficos
Autor(a) principal: Rama, TA
Data de Publicação: 2023
Outros Autores: Castells, M
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: https://hdl.handle.net/10216/154179
Resumo: Mastocytosis is associated with a high risk of anaphylaxis, in part due to drug hypersensitivity reactions (DHR). Drugs associated with mast cell activation include nonsteroidal anti-inflammatory drugs (NSAIDs), drugs used in the perioperative setting, including general anesthetics, neuromuscular blocking agents (NMBAs) and opiates/opioids, radiocontrast media (RCM), vaccines, and antibiotics such as quinolones and vancomycin. To protect patients against DHR and anaphylaxis, general avoidance of potential drug triggers is common practice, which often deprives patients of important drugs at times of need and limits their options. We aimed to critically review current evidence on the indications to avoid drugs in children and adults with mastocytosis. Recent data shows that general avoidance of drugs with potential mast cell activation action is not indicated in all patients with mastocytosis, but guidelines are lacking. Drugs tolerated before and after the onset of mastocytosis should not be avoided and a personalized approach is recommended to address drugs inducing mast cell activation. Pre-medication (RCM, local and general anesthetics, vaccines), use of safer alternatives (opioids, NBMAs, NSAIDs in selected cases), and drug challenges (NSAIDs in most cases) are recommended to increase the safety of patients with mastocytosis when introduced to new drugs.
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spelling Triggers of Anaphylaxis in Mastocytosis Patients: Evidence of the Current Drug-Avoidance RecommendationMastocytosisMast cell activationAnaphylaxisDrug hypersensitivityMastocytosis is associated with a high risk of anaphylaxis, in part due to drug hypersensitivity reactions (DHR). Drugs associated with mast cell activation include nonsteroidal anti-inflammatory drugs (NSAIDs), drugs used in the perioperative setting, including general anesthetics, neuromuscular blocking agents (NMBAs) and opiates/opioids, radiocontrast media (RCM), vaccines, and antibiotics such as quinolones and vancomycin. To protect patients against DHR and anaphylaxis, general avoidance of potential drug triggers is common practice, which often deprives patients of important drugs at times of need and limits their options. We aimed to critically review current evidence on the indications to avoid drugs in children and adults with mastocytosis. Recent data shows that general avoidance of drugs with potential mast cell activation action is not indicated in all patients with mastocytosis, but guidelines are lacking. Drugs tolerated before and after the onset of mastocytosis should not be avoided and a personalized approach is recommended to address drugs inducing mast cell activation. Pre-medication (RCM, local and general anesthetics, vaccines), use of safer alternatives (opioids, NBMAs, NSAIDs in selected cases), and drug challenges (NSAIDs in most cases) are recommended to increase the safety of patients with mastocytosis when introduced to new drugs.Springer20232023-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/10216/154179eng2196-305310.1007/s40521-023-00349-2Rama, TACastells, Minfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-11-29T15:06:21Zoai:repositorio-aberto.up.pt:10216/154179Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T00:15:44.075017Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Triggers of Anaphylaxis in Mastocytosis Patients: Evidence of the Current Drug-Avoidance Recommendation
title Triggers of Anaphylaxis in Mastocytosis Patients: Evidence of the Current Drug-Avoidance Recommendation
spellingShingle Triggers of Anaphylaxis in Mastocytosis Patients: Evidence of the Current Drug-Avoidance Recommendation
Rama, TA
Mastocytosis
Mast cell activation
Anaphylaxis
Drug hypersensitivity
title_short Triggers of Anaphylaxis in Mastocytosis Patients: Evidence of the Current Drug-Avoidance Recommendation
title_full Triggers of Anaphylaxis in Mastocytosis Patients: Evidence of the Current Drug-Avoidance Recommendation
title_fullStr Triggers of Anaphylaxis in Mastocytosis Patients: Evidence of the Current Drug-Avoidance Recommendation
title_full_unstemmed Triggers of Anaphylaxis in Mastocytosis Patients: Evidence of the Current Drug-Avoidance Recommendation
title_sort Triggers of Anaphylaxis in Mastocytosis Patients: Evidence of the Current Drug-Avoidance Recommendation
author Rama, TA
author_facet Rama, TA
Castells, M
author_role author
author2 Castells, M
author2_role author
dc.contributor.author.fl_str_mv Rama, TA
Castells, M
dc.subject.por.fl_str_mv Mastocytosis
Mast cell activation
Anaphylaxis
Drug hypersensitivity
topic Mastocytosis
Mast cell activation
Anaphylaxis
Drug hypersensitivity
description Mastocytosis is associated with a high risk of anaphylaxis, in part due to drug hypersensitivity reactions (DHR). Drugs associated with mast cell activation include nonsteroidal anti-inflammatory drugs (NSAIDs), drugs used in the perioperative setting, including general anesthetics, neuromuscular blocking agents (NMBAs) and opiates/opioids, radiocontrast media (RCM), vaccines, and antibiotics such as quinolones and vancomycin. To protect patients against DHR and anaphylaxis, general avoidance of potential drug triggers is common practice, which often deprives patients of important drugs at times of need and limits their options. We aimed to critically review current evidence on the indications to avoid drugs in children and adults with mastocytosis. Recent data shows that general avoidance of drugs with potential mast cell activation action is not indicated in all patients with mastocytosis, but guidelines are lacking. Drugs tolerated before and after the onset of mastocytosis should not be avoided and a personalized approach is recommended to address drugs inducing mast cell activation. Pre-medication (RCM, local and general anesthetics, vaccines), use of safer alternatives (opioids, NBMAs, NSAIDs in selected cases), and drug challenges (NSAIDs in most cases) are recommended to increase the safety of patients with mastocytosis when introduced to new drugs.
publishDate 2023
dc.date.none.fl_str_mv 2023
2023-01-01T00:00:00Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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status_str publishedVersion
dc.identifier.uri.fl_str_mv https://hdl.handle.net/10216/154179
url https://hdl.handle.net/10216/154179
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 2196-3053
10.1007/s40521-023-00349-2
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dc.publisher.none.fl_str_mv Springer
publisher.none.fl_str_mv Springer
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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