Drug-Induced Anaphylaxis Uncommon in Mastocytosis: Findings From Two Large Cohorts

BACKGROUND: Anaphylaxis is a common feature of patients with mastocytosis, particularly with Hymenoptera venoms. Hence, it is hypothesized that patients with mastocytosis may have an increased susceptibility to developing drug-induced anaphylaxis (DIA). Patients and medical practitioners are therefore concerned when there is a need to use various drugs. However, this issue has not been systematically investigated. OBJECTIVE: To investigate the prevalence and clinical characteristics of anaphylaxis to various types of drugs among patients with mastocytosis. METHODS: A retrospective study was conducted among 470 consecutive patients (18 years and older) with con fi rmed clonal mast cell diseases recruited from 2 independent mastocytosis reference centers. All patients underwent a comprehensive, individualized allergy workup with evaluation of the (self) reported drug hypersensitivity. RESULTS: The overall prevalence of DIA was 6.3%, accounting for one-third of the con fi rmed drug hypersensitivity reactions. Nonsteroidal anti-in fl ammatory drugs were the most common elicitors of DIA (56%), followed by perioperative agents (23%) and antibiotics (13%). Anaphylactic reactions were severe in most cases, with 43% of patients experiencing hypotensive syncope. All drug-related hypersensitivity reactions occurred before mastocytosis was diagnosed. CONCLUSIONS: The prevalence of DIA in mastocytosis tends to be higher than in the general population, but is overall low. However, its severity is more pronounced. Our results suggest that patients with mastocytosis with a previous reaction to drugs should undergo a thorough allergy workup. Well-tolerated drugs can be further used without speci fi c precautions. (c) 2024 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/). (J Allergy Clin Immunol Pract 2024;12:1850-62)