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Thomas EG, Thomas DJ. Mimics of Allergy and Angioedema: Scombroid, Mast Cell Activation Disorders, and Hereditary Alpha Tryptasemia. Immunol Allergy Clin North Am 2023; 43:553-568. [PMID: 37394259 DOI: 10.1016/j.iac.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Scombroid poisoning, systemic mastocytosis, and hereditary alpha tryptasemia all present with episodes that resemble allergic reactions. Knowledge regarding systemic mastocytosis and hereditary alpha tryptasemia is quickly evolving. Epidemiology, pathophysiology, and strategies to identify and diagnose are discussed. Evidence-based management in the emergency setting and beyond is also explored and summarized. Key differences are described between these events and allergic reactions.
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Affiliation(s)
- Elizabeth G Thomas
- Department of Emergency Medicine, Ochsner Medical Center, 1514 Jefferson Highway, Jefferson, New Orleans, LA 70121, USA.
| | - Daniel James Thomas
- Department of Emergency Medicine, Ochsner Medical Center, 1514 Jefferson Highway, Jefferson, New Orleans, LA 70121, USA
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2
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How persons with systemic mastocytosis describe the time between symptom onset and receiving diagnosis. Prim Health Care Res Dev 2022; 23:e54. [PMID: 36069067 PMCID: PMC9472238 DOI: 10.1017/s146342362200024x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM The aim of the study was to explore how persons with systemic mastocytosis (SM) described the time between the onset of symptoms and signs and getting the diagnosis. BACKGROUND SM is a rare disease caused by the accumulation of clonal mast cells with abnormal function. The symptoms and signs of the disease are varied, often diffuse and affect individuals differently. Due to this complexity, a multi-disciplinary diagnostic approach is required, in which general practitioners play an important part in identifying and referring patients relevant for such investigations. METHODS Sixteen persons with SM were interviewed about their experiences of the time before the diagnosis was received. Systematic text condensation was used in the analysis process. FINDINGS The time between symptom and signs onset and diagnosis was perceived as difficult. SM often had a complex and unpredictable effect on a person's daily life, long before diagnosis. In the analysis, three themes were found. Having symptoms and signs with an unknown cause included the participants' descriptions of numerous symptoms and signs, often years before diagnosis. These could be severe and result in worries for both participants and their next-of-kin. Dealing with the symptoms and signs encompassed the different ways in which the participants coped with the symptoms and signs, and sought relief. Being a patient without a diagnosis underlined the lack of information and knowledge within healthcare, often resulting in a delayed or incorrect diagnosis. The study highlighted the importance of a person-centred approach and the need to increase knowledge of the disease within primary care, to shorten this stressful and vulnerable time.
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3
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Lakritz S, Forsberg PA, Sherbenou DW, Mark TM. Lenalidomide‐induced autoimmune enteropathy complicating treatment of multiple myeloma with concurrent systemic mastocytosis. Clin Case Rep 2022; 10:e6199. [PMID: 36188028 PMCID: PMC9483819 DOI: 10.1002/ccr3.6199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/14/2022] [Accepted: 05/20/2022] [Indexed: 11/07/2022] Open
Abstract
Lenalidomide is an IMiD drug which has been associated with a variety of potential immune related complications. We describe the case of a patient with newly diagnosed multiple myeloma along with a history of systemic mastocytosis who developed evidence of an autoimmune enteropathy shortly after initiating lenalidomide based therapy.
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Affiliation(s)
- Stephanie Lakritz
- Department of Medicine, Division of Hematology University of Colorado School of Medicine Aurora Colorado USA
| | - Peter A. Forsberg
- Department of Medicine, Division of Hematology University of Colorado School of Medicine Aurora Colorado USA
| | - Daniel W. Sherbenou
- Department of Medicine, Division of Hematology University of Colorado School of Medicine Aurora Colorado USA
| | - Tomer M. Mark
- Department of Medicine, Division of Hematology University of Colorado School of Medicine Aurora Colorado USA
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4
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Barozzi E, Bucelli C, Grifoni FI, Gianelli U, Iurlo A, Cattaneo D. Successful Imatinib Treatment for Systemic Mastocytosis Associated With Myelodysplastic/Myeloproliferative Neoplasm: Report of a Case and Literature Review. Front Oncol 2022; 11:819097. [PMID: 35096623 PMCID: PMC8790034 DOI: 10.3389/fonc.2021.819097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/16/2021] [Indexed: 12/16/2022] Open
Abstract
Systemic mastocytosis (SM) is a heterogeneous disease characterized by the expansion of mast cells in one or more tissues, frequently characterized by the presence of KITD816V mutation. The updated World Health Organization (WHO) classification of myeloid neoplasms recognizes SM with an associated hematological neoplasm (SM-AHN) as a new subtype among the others, which is depicted by the coexistence of SM with another hematological clonal disease. Prognosis is very different among SM patients, while its treatment, although highly personalized, is still challenging. Here we report a case of KITD816V-unmutated SM associated with MDS/MPN successfully treated with imatinib.
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Affiliation(s)
- Enrico Barozzi
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Cristina Bucelli
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Irene Grifoni
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Umberto Gianelli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Division of Pathology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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5
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Mast cells and eosinophilic granule cells in Oncorhynchus mykiss: Are they similar or different? FISH AND SHELLFISH IMMUNOLOGY REPORTS 2021; 2:100029. [DOI: 10.1016/j.fsirep.2021.100029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/06/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
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6
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Thomas EG, Thomas DJ. Mimics of Allergy and Angioedema: Scombroid, Mast Cell Activation Disorders, and Hereditary Alpha Tryptasemia. Emerg Med Clin North Am 2021; 40:119-133. [PMID: 34782083 DOI: 10.1016/j.emc.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Scombroid poisoning, systemic mastocytosis, and hereditary alpha tryptasemia all present with episodes that resemble allergic reactions. Knowledge regarding systemic mastocytosis and hereditary alpha tryptasemia is quickly evolving. Epidemiology, pathophysiology, and strategies to identify and diagnose are discussed. Evidence-based management in the emergency setting and beyond is also explored and summarized. Key differences are described between these events and allergic reactions.
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Affiliation(s)
- Elizabeth G Thomas
- Department of Emergency Medicine, Ochsner Medical Center, 1514 Jefferson Highway, Jefferson, New Orleans, LA 70121, USA.
| | - Daniel James Thomas
- Department of Emergency Medicine, Ochsner Medical Center, 1514 Jefferson Highway, Jefferson, New Orleans, LA 70121, USA
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7
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Constantin C, Pisani A, Bardi G, Neagu M. Nano-carriers of COVID-19 vaccines: the main pillars of efficacy. Nanomedicine (Lond) 2021; 16:2377-2387. [PMID: 34632802 PMCID: PMC8544481 DOI: 10.2217/nnm-2021-0250] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/09/2021] [Indexed: 12/30/2022] Open
Abstract
As the current COVID-19 pandemic illustrates, vaccination is the most powerful method of disease prevention and public confidence in vaccines depends on their safety and efficacy. The information gathered in the current pandemic is growing at an accelerated pace. Both the key vital protein DNA/RNA messengers and the delivery carriers are the elements of a puzzle including their interactions with the immune system to suppress SARS-CoV-2 infection. A new nano-era is beginning in the vaccine development field and an array of side applications for diagnostic and antiviral tools will likely emerge. This review focuses on the evolution of vaccine carriers up to COVID-19-aimed nanoparticles and the immune-related adverse effects imposed by these nanocarriers.
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Affiliation(s)
- Carolina Constantin
- “Victor Babeş” National Institute of Pathology, 99-101 Spl Independentei, Bucharest, 050096, Romania
- Colentina Clinical Hospital, 19-21, Sos. Stefan cel Mare, Bucharest, Romania
| | - Anissa Pisani
- Nanobiointeractions & Nanodiagnostics, Istituto Italiano di Tecnologia, Via Morego 30, Genova, 16163, Italy
- Department of Chemistry & Industrial Chemistry, University of Genova, Via Dodecaneso 31, Genova, 16146, Italy
| | - Giuseppe Bardi
- Nanobiointeractions & Nanodiagnostics, Istituto Italiano di Tecnologia, Via Morego 30, Genova, 16163, Italy
| | - Monica Neagu
- “Victor Babeş” National Institute of Pathology, 99-101 Spl Independentei, Bucharest, 050096, Romania
- Colentina Clinical Hospital, 19-21, Sos. Stefan cel Mare, Bucharest, Romania
- University of Bucharest, 93–95 Spl Independentei, Bucharest, Romania
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Suppa M, Marino L, Piccari P, Masselli G, Gradini R. Cardiac complications in a patient affected by systemic mastocytosis and primitive myelofibrosis: A case report. Clin Case Rep 2021; 9:e04972. [PMID: 34804526 PMCID: PMC8587177 DOI: 10.1002/ccr3.4972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open
Abstract
Systemic mastocytosis with associated primitive myelofibrosis is a rare and complex disease with a difficult therapeutic management. The release of several inflammation mediators can trigger acute cardiovascular events.
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Affiliation(s)
- Marianna Suppa
- Emergency DepartmentUmberto I HospitalUniversity Sapienza of RomeRomeItaly
| | - Luca Marino
- Emergency DepartmentUmberto I HospitalUniversity Sapienza of RomeRomeItaly
- Mechanical and Aerospace DepartmentUniversity Sapienza of RomeRomeItaly
| | - Pietro Piccari
- Emergency DepartmentUmberto I HospitalUniversity Sapienza of RomeRomeItaly
| | - Gabriele Masselli
- Radiology DepartmentUmberto I HospitalUniversity Sapienza of RomeRomeItaly
| | - Roberto Gradini
- Department of Experimental MedicineUniversity Sapienza of RomeRomeItaly
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9
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Ruksha TG, Sergeeva EY, Fefelova YA, Khorzhevsky VA. [The significance of C-KIT gene mutations in the diagnosis and prognosis of malignant tumors]. Arkh Patol 2021; 83:61-68. [PMID: 34278763 DOI: 10.17116/patol20218304161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Mutations in the C-KIT gene encoding type III receptor tyrosine kinase that regulates cellular processes, such as differentiation, survival, proliferation, migration, and apoptosis, are found in some neoplasms: gastrointestinal stromal tumor, mastocytosis, melanoma, breast carcinomas, myeloid leukemias, and a number of others. Tumors that exhibit these mutations are sensitive to therapy with tyrosine kinase inhibitors, which makes it necessary to correctly identify the mutation status by C-KIT in order to apply a personalized approach to therapy. This literature review shows that the type and localization of the C-KIT gene mutation are of crucial prognostic value and significance in choosing drugs for antitumor therapy, but traditional diagnostic methods fail to determine accurate mutation characteristics. Routine sequencing techniques focus on identifying the gene mutations associated with specific cellular processes, such as DNA damage and repair. The emergence of next-generation sequencing techniques has solved this problem, making it possible to fully analyze the genome of a malignant neoplasm, with constant screening for new mutations that appear as the tumor develops, affect the prognosis of the disease, and change its sensitivity to the antitumor therapy.
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Affiliation(s)
- T G Ruksha
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University of the Ministry of Health of Russia, Krasnoyarsk, Russia
| | - E Yu Sergeeva
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University of the Ministry of Health of Russia, Krasnoyarsk, Russia
| | - Yu A Fefelova
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University of the Ministry of Health of Russia, Krasnoyarsk, Russia
| | - V A Khorzhevsky
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University of the Ministry of Health of Russia, Krasnoyarsk, Russia
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Abstract
BACKGROUND Apps have become part of our daily lives. Apps for pruritus could also play a role in the management of symptoms. AIM The aim of this article is to review existing apps for pruritus. In addition, we will discuss whether these apps have been validated and how and which offers might still be lacking. MATERIALS AND METHODS The two largest app stores as well as PubMed and Google were searched for apps regarding pruritus. Relevant medical apps were documented and categorized with respect to their functions. PubMed was searched to identify validation studies. RESULTS In total 21 apps for pruritus were identified. Of those 12 explicitly focused on pruritus, while 8 included pruritus as a symptom of an underlying disease (especially eczema and urticaria). The following app categories were derived: medical history of chronic pruritus, assessment of pruritus in clinical trials, assessment of nocturnal pruritus, information about pruritus, and diseases with pruritus as a symptom. Three of the apps with explicit focus on pruritus have been scientifically validated. DISCUSSION There are different apps for pruritus available. Most apps which explicitly focus on pruritus are aimed at physicians and scientists, while apps for diseases with pruritus as a symptom are more patient-centered. Due to technological advances, apps and wearables could improve management of pruritus in the future.
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Affiliation(s)
- B Schuster
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Fakultät für Medizin, Technische Universität München, München, Deutschland
| | - M Dugas
- Institut für Medizinische Informatik, Medizinische Fakultät, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - A Zink
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Fakultät für Medizin, Technische Universität München, München, Deutschland.
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Wu CP, Lusvarghi S, Wang JC, Hsiao SH, Huang YH, Hung TH, Ambudkar SV. Avapritinib: A Selective Inhibitor of KIT and PDGFRα that Reverses ABCB1 and ABCG2-Mediated Multidrug Resistance in Cancer Cell Lines. Mol Pharm 2019; 16:3040-3052. [PMID: 31117741 DOI: 10.1021/acs.molpharmaceut.9b00274] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The frequent occurrence of multidrug resistance (MDR) conferred by the overexpression of ATP-binding cassette (ABC) transporters ABCB1 and ABCG2 in cancer cells remains a therapeutic obstacle for scientists and clinicians. Consequently, developing or identifying modulators of ABCB1 and ABCG2 that are suitable for clinical practice is of great importance. Therefore, we have explored the drug repositioning approach to identify candidate modulators of ABCB1 and ABCG2 from tyrosine kinase inhibitors with known pharmacological properties and anticancer activities. In this study, we discovered that avapritinib (BLU-285), a potent, selective, and orally bioavailable tyrosine kinase inhibitor against mutant forms of KIT and platelet-derived growth factor receptor alpha (PDGFRA), attenuates the transport function of both ABCB1 and ABCG2. Moreover, avapritinib restores the chemosensitivity of ABCB1- and ABCG2-overexpressing MDR cancer cells at nontoxic concentrations. These findings were further supported by results of apoptosis induction assays, ATP hydrolysis assays, and docking of avapritinib in the drug-binding pockets of ABCB1 and ABCG2. Altogether, our study highlights an additional action of avapritinib on ABC drug transporters, and a combination of avapritinib with conventional chemotherapy should be further investigated in patients with MDR tumors.
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Affiliation(s)
- Chung-Pu Wu
- Department of Obstetrics and Gynecology , Taipei Chang Gung Memorial Hospital , Taipei 105 , Taiwan
| | - Sabrina Lusvarghi
- Laboratory of Cell Biology, Center for Cancer Research , National Cancer Institute , Bethesda , Maryland 20892 , United States
| | | | | | | | - Tai-Ho Hung
- Department of Obstetrics and Gynecology , Taipei Chang Gung Memorial Hospital , Taipei 105 , Taiwan
| | - Suresh V Ambudkar
- Laboratory of Cell Biology, Center for Cancer Research , National Cancer Institute , Bethesda , Maryland 20892 , United States
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de Grazia R, Apt P, Ibarra Á, Sazunic I. Mastocitosis cutánea maculopapular infantil: reporte de un caso. REVISTA MÉDICA CLÍNICA LAS CONDES 2019. [DOI: 10.1016/j.rmclc.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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13
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Hussain A, Sanders M, Riotte C, Hussain N. Full-term newborn infant with blistering skin lesions-Caution regarding use of pain medications. Pediatr Dermatol 2019; 36:362-364. [PMID: 30854684 DOI: 10.1111/pde.13794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Multiple opioids are known to trigger mast cell degranulation. We report the case of a neonate with blistering skin lesions at birth who died of multi-organ failure after administration of morphine. Given the excessive histamine release and potential complications associated with morphine administration, alternative opioids and adjuvants should be considered in infants presenting with evidence of bullous or infiltrative skin lesions until mastocytosis is ruled out.
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Affiliation(s)
- Aamir Hussain
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Melinda Sanders
- Department of Pathology, University of Connecticut, Farmington, Connecticut
| | - Clare Riotte
- Department of Pediatrics, Division of Pain and Palliative Medicine, University of Connecticut, Farmington, Connecticut
| | - Naveed Hussain
- Department of Pediatrics, Division of Neonatology, University of Connecticut, Farmington, Connecticut
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Gebreyohannes YK, Wozniak A, Zhai ME, Wellens J, Cornillie J, Vanleeuw U, Evans E, Gardino AK, Lengauer C, Debiec-Rychter M, Sciot R, Schöffski P. Robust Activity of Avapritinib, Potent and Highly Selective Inhibitor of Mutated KIT, in Patient-derived Xenograft Models of Gastrointestinal Stromal Tumors. Clin Cancer Res 2018; 25:609-618. [DOI: 10.1158/1078-0432.ccr-18-1858] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/09/2018] [Accepted: 09/25/2018] [Indexed: 11/16/2022]
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Ha NH, Lee YJ, Park MC, Lee IJ, Kim SM, Park DH. Solitary mastocytoma presenting at birth. Arch Craniofac Surg 2018; 19:127-130. [PMID: 29716178 PMCID: PMC6057127 DOI: 10.7181/acfs.2018.01508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/31/2018] [Indexed: 11/11/2022] Open
Abstract
Mastocytosis is a rare disease which occurs in both children and adults, and it can manifest as a solitary or multiple skin lesions. Both can cause cutaneous or systemic symptoms. Because of the heterogeneity of clinical presentation of mastocytosis and its rare prevalence, it can be hard to suspect the mastocytosis at the first time. Most solitary mastocytomas are about 1-5 cm in diameter and have features of brownish-yellow, minimally elevated plaques with a smooth shiny surface. This article presents a case of solitary mastocytoma which occurred in neonate and that we treated through surgical excision. In histopathological examination, it consisted of c-kit-positive mast cells. Although pediatric cutaneous mastocytosis might regress spontaneously, clinicians should keep in mind that it could be associated with systemic mastocytosis which involves hematopoietic system.
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Affiliation(s)
- Non Hyeon Ha
- Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, Korea
| | - Yoo Jung Lee
- Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, Korea
| | - Myong Chul Park
- Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, Korea
| | - Il Jae Lee
- Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, Korea
| | - Sue Min Kim
- Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, Korea
| | - Dong Ha Park
- Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, Korea
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Le M, Miedzybrodzki B, Olynych T, Chapdelaine H, Ben-Shoshan M. Natural history and treatment of cutaneous and systemic mastocytosis. Postgrad Med 2017; 129:896-901. [PMID: 28770635 DOI: 10.1080/00325481.2017.1364124] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Mastocytosis, a heterogeneous group of disorders, is characterized by an abnormal increase in the number of mast cells that is limited to the skin (cutaneous mastocytosis), involving extracutaneous tissues (systemic mastocytosis), or presenting as solid tumours (mastocytoma and mast cell sarcoma). Recent studies estimate that 1 in 10,000 people are diagnosed with mastocytosis. Although prompt diagnosis and appropriate management are crucial, little is known about the natural history and currently there are no established management guidelines. We have conducted a systematic review to assess the natural history and management of different mastocytosis subtypes. METHODS A systematic review and meta-analysis were conducted using the PubMed and Ovid database of studies published in English and French over the last fifteen years, from January 2001 to December 2016. Keywords 'Cutaneous mastocytosis', 'Systemic mastocytosis', 'pathophysiology', 'clinical course', 'prognosis', 'drug therapy', and 'therapy' were searched. Rate of complete resolution was subjected to pooled analysis for different mastocytosis subtypes. Meta-analysis was conducted using Stata version 12.0. RESULTS We reviewed 634 papers, of which 5 were included in the analysis of resolution, and 138 were included in the assessment of management. Pooled estimate for rate of complete resolution varied depending on the mastocytosis subtype. In cutaneous mastocytosis, the complete resolution rate for mastocytoma was 10% per year (95% CI: 4.8%, 15.1%) while the rate for urticaria pigmentosa was 1.9% per year (95% CI: -0.5%, 4.3%). Diffuse cutaneous mastocytosis and systemic mastocytosis subtypes did not show evidence of complete resolution in the studies reviewed. Treatment of cutaneous and systemic mastocytosis is purely symptomatic with topical corticosteroids, antihistamines, omalizumab and imatinib being common choices. CONCLUSION Rate of resolution of mastocytosis is only shown in urticaria pigmentosa and mastocytoma. Better management guidelines are required to improve the health of these patients.
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Affiliation(s)
- Michelle Le
- a Division of Allergy, Immunology and Dermatology, Department of Pediatrics , McGill University Health Centre, Montreal Children's Hospital , Montreal , Canada
| | - Barbara Miedzybrodzki
- a Division of Allergy, Immunology and Dermatology, Department of Pediatrics , McGill University Health Centre, Montreal Children's Hospital , Montreal , Canada
| | - Tim Olynych
- b Department of Medicine , The Ottawa Hospital , Ottawa , Canada
| | - Hugo Chapdelaine
- c Division of Allergy and Immunology, Department of Medicine , Centre Universitaire de Montréal, Cliniques de Montréal , Montreal , Canada
| | - Moshe Ben-Shoshan
- a Division of Allergy, Immunology and Dermatology, Department of Pediatrics , McGill University Health Centre, Montreal Children's Hospital , Montreal , Canada
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Weiner J, Marano A, Cardones A, Criscione-Schreiber L. Fever, Joint Pain, Seizures, and Rash in a 53-Year-Old Woman. Arthritis Care Res (Hoboken) 2017; 69:1437-1443. [PMID: 28376294 DOI: 10.1002/acr.23248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/03/2017] [Accepted: 03/28/2017] [Indexed: 11/08/2022]
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