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López Sanz P, Guerrero Ramírez C, Manso Córdoba S, Alfaro Martínez ME, Bascuñana Mendoza A, Gómez Sánchez ME, Martínez Martínez ML, Azaña Defez JM. COVID-19 infection and vaccination in 92 pediatric patients with cutaneous mastocytosis: A retrospective, cross-sectional study. Pediatr Dermatol 2024; 41:458-460. [PMID: 38305078 DOI: 10.1111/pde.15551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 01/21/2024] [Indexed: 02/03/2024]
Abstract
Mast cells (MCs) can release a variety of biologically active mediators under different circumstances, such as fever or vaccination. Our aim was to evaluate the incidence and severity of MC activation symptoms induced by SARS-CoV-2 virus (COVID-19) infection and vaccination in a cohort of 92 pediatric patients with cutaneous mastocytosis. Our findings support previous evidence on the safety of COVID-19 infection and vaccination in patients with MC disorders.
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Affiliation(s)
- Pablo López Sanz
- Department of Dermatology, Hospital General Universitario de Albacete, Castilla-La Mancha, Spain
| | | | - Silvia Manso Córdoba
- Department of Dermatology, Hospital General Universitario de Albacete, Castilla-La Mancha, Spain
| | | | - Alicia Bascuñana Mendoza
- Department of Dermatology, Hospital General Universitario de Albacete, Castilla-La Mancha, Spain
| | | | | | - José Manuel Azaña Defez
- Department of Dermatology, Hospital General Universitario de Albacete, Castilla-La Mancha, Spain
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Gouveia J, Rodrigues MA, Fernandes I, Cabral R, Falcão H. Safety of a mRNA COVID-19 Vaccine in Patients with Indolent Systemic Mastocytosis. ACTA MEDICA PORT 2024; 37:224-225. [PMID: 38430469 DOI: 10.20344/amp.20851] [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] [Received: 10/22/2023] [Accepted: 12/11/2023] [Indexed: 03/03/2024]
Affiliation(s)
- Joana Gouveia
- Serviço de Imunoalergologia. Centro Hospitalar Universitário de Santo António. Porto. Portugal
| | | | - Iolanda Fernandes
- Serviço de Dermatologia. Centro Hospitalar Universitário de Santo António. Porto; Consulta Multidisciplinar de Linfomas Cutâneos e Mastocitoses. Centro Hospitalar Universitário de Santo António. Porto; Unidade Multidisciplinar de Investigação Biomédica. Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto. Portugal
| | - Renata Cabral
- Serviço de Imunoalergologia. Centro Hospitalar Universitário de Santo António. Porto. Portugal
| | - Helena Falcão
- Serviço de Imunoalergologia. Centro Hospitalar Universitário de Santo António. Porto. Portugal
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Nicola S, Mazzola M, Lo Sardo L, Montabone E, Badiu I, Corradi F, Azzolina MCR, Dall’Acqua MG, Rolla G, Ridolfi I, Quinternetto A, Brussino L. Safety and Tolerability of COVID-19 Vaccine in Mast Cell Disorders Real-Life Data from a Single Centre in Italy. Vaccines (Basel) 2024; 12:202. [PMID: 38400185 PMCID: PMC10893122 DOI: 10.3390/vaccines12020202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Background In the past three years, COVID-19 has had a significant impact on the healthcare systems and people's safety worldwide. Mass vaccinations dramatically improved the health and economic damage caused by SARS-CoV-2. However, the safety of COVID-19 vaccines in patients at high risk of allergic reactions still has many unmet needs that should be clarified. Material and methods A retrospective, single-centre study was performed by collecting demographic and clinical data of patients with Mast Cell Disorders (MCDs) to evaluate the safety and tolerability of COVID-19 vaccinations. Moreover, any changes in the natural history of the underlying disease following the vaccine have been evaluated. Results This study included 66 patients affected with MCDs. Out of them, 52 (78.8%) received a COVID-19 vaccination and 41 (78.8%) completed the vaccination course. Premedication came first in 86.6% of our patients. A total of seven (4.5%) patients complained about an immediate reaction and two (1.3%) had a late reaction. Worsening of MCD history was observed in a single patient. Conclusions Despite the overall high risk of allergic reactions, our study did not reveal any increased risk for SARS-CoV-2 allergic reactions in MCD patients, thus supporting the recommendation in favour of the SARS-CoV-2 vaccination. However, due to the potentially increased rate of anaphylactic reactions, MCD patients should receive vaccine premedication and should be treated in a hospital setting after an allergological specialistic evaluation.
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Affiliation(s)
- Stefania Nicola
- SCDU Immunologia e Allergologia, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (S.N.); (M.M.); (L.L.S.); (E.M.); (I.B.); (F.C.); (A.Q.); (L.B.)
- Department of Medical Sciences, University of Torino, C.so AM Dogliotti, 14, 10126 Torino, Italy;
| | - Marina Mazzola
- SCDU Immunologia e Allergologia, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (S.N.); (M.M.); (L.L.S.); (E.M.); (I.B.); (F.C.); (A.Q.); (L.B.)
- Department of Medical Sciences, University of Torino, C.so AM Dogliotti, 14, 10126 Torino, Italy;
| | - Luca Lo Sardo
- SCDU Immunologia e Allergologia, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (S.N.); (M.M.); (L.L.S.); (E.M.); (I.B.); (F.C.); (A.Q.); (L.B.)
| | - Erika Montabone
- SCDU Immunologia e Allergologia, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (S.N.); (M.M.); (L.L.S.); (E.M.); (I.B.); (F.C.); (A.Q.); (L.B.)
- Department of Medical Sciences, University of Torino, C.so AM Dogliotti, 14, 10126 Torino, Italy;
| | - Iuliana Badiu
- SCDU Immunologia e Allergologia, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (S.N.); (M.M.); (L.L.S.); (E.M.); (I.B.); (F.C.); (A.Q.); (L.B.)
| | - Federica Corradi
- SCDU Immunologia e Allergologia, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (S.N.); (M.M.); (L.L.S.); (E.M.); (I.B.); (F.C.); (A.Q.); (L.B.)
| | - Maria Carmen Rita Azzolina
- Health Direction, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (M.C.R.A.)
| | | | - Giovanni Rolla
- Department of Medical Sciences, University of Torino, C.so AM Dogliotti, 14, 10126 Torino, Italy;
| | - Irene Ridolfi
- Department of Medical Sciences, University of Torino, C.so AM Dogliotti, 14, 10126 Torino, Italy;
| | - Anna Quinternetto
- SCDU Immunologia e Allergologia, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (S.N.); (M.M.); (L.L.S.); (E.M.); (I.B.); (F.C.); (A.Q.); (L.B.)
- Department of Medical Sciences, University of Torino, C.so AM Dogliotti, 14, 10126 Torino, Italy;
| | - Luisa Brussino
- SCDU Immunologia e Allergologia, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (S.N.); (M.M.); (L.L.S.); (E.M.); (I.B.); (F.C.); (A.Q.); (L.B.)
- Department of Medical Sciences, University of Torino, C.so AM Dogliotti, 14, 10126 Torino, Italy;
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Giannetti MP, Nicoloro-SantaBarbara J, Godwin G, Middlesworth J, Espeland A, Douvas JL, Castells MC. Challenges in Drug and Hymenoptera Venom Hypersensitivity Diagnosis and Management in Mastocytosis. Diagnostics (Basel) 2024; 14:123. [PMID: 38247999 PMCID: PMC10814166 DOI: 10.3390/diagnostics14020123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
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.
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Affiliation(s)
- Matthew P. Giannetti
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Jennifer Nicoloro-SantaBarbara
- Harvard Medical School, Boston, MA 02115, USA
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Grace Godwin
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Julia Middlesworth
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Andrew Espeland
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Julia L. Douvas
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Mariana C. Castells
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
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Zhu CK, Nguyen A, Prosty C, Gabrielli S, Mulé P, Netchiporouk E, Le M, Zhang X, Shand G, Baum S, Hakroush R, Greenberger S, Ollech A, Miedzybrodzki B, Ben-Shoshan M. Safety of COVID-19 mRNA vaccination and effects of SARS-CoV-2 infection in children and adults with mast cell disorders. Clin Exp Med 2023; 23:4937-4942. [PMID: 37837561 DOI: 10.1007/s10238-023-01213-y] [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] [Received: 08/23/2023] [Accepted: 09/30/2023] [Indexed: 10/16/2023]
Abstract
Mastocytosis is characterized by abnormal clonal mast cell proliferation. Given the paucity of data in patients with mastocytosis, it is crucial to assess the safety of COVID-19 vaccines in this population. We aimed to assess the risk of allergic reactions and the effect of COVID-19 infection among patients with mastocytosis. Participants were recruited from Canada and Israel between December 2021 and May 2022. Consenting participants were administered standardized questionnaires querying whether they were infected with COVID-19, if they received the first and second dose vaccines, and post-vaccination side effects including allergic reactions (urticaria/angioedema, current rash flaring, need for updosing medications, or respiratory symptoms) and common side effects including injection site reaction (ISR) and flu-like symptoms. Forty participants with mastocytosis were administered a standardized questionnaire (median age = 9, 59% male). Amongst all participants, 16 (39%) reported COVID-19 infection and most (75%) reported flu-like symptoms, 3 (19%) were asymptomatic, 1 suffered from shortness of breath/chest pain and 1 from facial flushing. Of the 25 participants who were eligible for vaccination (≥ 5 years old), 80% received a first-dose vaccine and 68% received a second-dose vaccine. Of those who received the first-dose vaccine, most (60%) remained asymptomatic, 20% developed flu-like symptoms, 20% had an ISR, and 1 patient had an allergic reaction (urticaria and swelling). Of those who received the second-dose vaccine, most (53%) were asymptomatic, and 1 had an allergic reaction. No significant difference was found between side effects of both vaccine doses. No reactions fulfilled the criteria for anaphylaxis in either dose. This study reveals that among patients with mastocytosis, COVID-19 vaccine and infection were well-tolerated in the majority of cases.
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Affiliation(s)
- Catherine K Zhu
- Faculty of Medicine, McGill University, 1001 Décarie Blvd, Montréal, QC, H4A 3J1, Canada.
| | - Alex Nguyen
- Faculty of Medicine, McGill University, 1001 Décarie Blvd, Montréal, QC, H4A 3J1, Canada
| | - Connor Prosty
- Faculty of Medicine, McGill University, 1001 Décarie Blvd, Montréal, QC, H4A 3J1, Canada
| | - Sofianne Gabrielli
- Faculty of Medicine, McGill University, 1001 Décarie Blvd, Montréal, QC, H4A 3J1, Canada
| | - Pasquale Mulé
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montréal, QC, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montréal, QC, Canada
| | - Michelle Le
- Division of Dermatology, McGill University Health Centre, Montréal, QC, Canada
| | - Xun Zhang
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Greg Shand
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Sharon Baum
- Department of Dermatology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Reman Hakroush
- Pediatric Dermatology Service, Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Shoshana Greenberger
- Pediatric Dermatology Service, Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Ayelet Ollech
- Pediatric Dermatology Service, Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | | | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montréal, QC, Canada
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Stone CA, Garvey LH, Nasser S, Lever C, Triggiani M, Parente R, Phillips EJ. Identifying and Managing Those at Risk for Vaccine-Related Allergy and Anaphylaxis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2008-2022. [PMID: 37182566 DOI: 10.1016/j.jaip.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/13/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
Immediate hypersensitivity reactions to vaccines, the most severe of which is anaphylaxis, are uncommon events occurring in fewer than 1 in a million doses administered. These reactions are infrequently immunoglobulin E-mediated. Because they are unlikely to recur, a reaction to a single dose of a vaccine is rarely a contraindication to redosing. This narrative review article contextualizes the recent knowledge we have gained from the coronavirus 2019 (COVID-19) pandemic rollout of the new mRNA platform with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines within the much broader context of what is known about immediate reactions to other vaccinations of routine and global importance. We focus on what is known about evidence-based approaches to diagnosis and management and what is new in our understanding of mechanisms of immediate vaccine reactions. Specifically, we review the epidemiology of immediate hypersensitivity vaccine reactions, differential diagnosis for immune-mediated and nonimmune reaction clinical phenotypes, including how to recognize immunization stress-related responses. In addition, we highlight what is known about mechanisms and review the rare but important contribution of excipient allergies and specifically when to consider testing for them as well as other key features that contribute to safe evaluation and management.
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Affiliation(s)
- Cosby A Stone
- Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Shuaib Nasser
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Charley Lever
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Roberta Parente
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Elizabeth J Phillips
- Department of Dermatology, Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn; Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tenn; Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch, Perth, Western Australia.
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Bonadonna P, Olivieri F, Jarkvist J, Nalin F, Zanotti R, Maclachlan L, Gülen T. Non-steroidal anti-inflammatory drug-induced anaphylaxis infrequent in 388 patients with mastocytosis: A two-center retrospective cohort study. FRONTIERS IN ALLERGY 2022; 3:1071807. [PMID: 36545345 PMCID: PMC9760711 DOI: 10.3389/falgy.2022.1071807] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/14/2022] [Indexed: 12/08/2022] Open
Abstract
Background Anaphylaxis is a well-known feature of mastocytosis, particularly in relation to hymenoptera venom stings. It is therefore hypothesized that mastocytosis patients may also be predisposed to severe hypersensitivity reactions to certain medications including non-steroidal anti-inflammatory drugs (NSAIDs). For this reason, these patients are usually discouraged from using these drugs. The current study aimed to determine the prevalence and evaluate the severity of NSAID-related hypersensitivity reactions among patients with mastocytosis. Methods A retrospective study was conducted among a total of 388 (≥18 years old) consecutive patients from two independent European mastocytosis centers, in Sweden and Italy. Patients underwent a thorough allergy work-up where self-reported NSAID-hypersensitivity reactions were re-evaluated by an allergist in the first cohort (202 patients) and results were validated in the second cohort (186 patients). Results Overall frequency of NSAID-hypersensitivity was 11.3% in the total study cohort. Most patients reacted with cutaneous symptoms (89%), whereas severe hypersensitivity reactions were infrequent with only 11 patients (2.8%) experiencing anaphylaxis. All NSAID-related hypersensitivity reactions had occurred before mastocytosis was diagnosed. There was no difference between the groups regarding gender, baseline tryptase levels or presence of atopy, asthma/rhinitis. Conclusion Our study indicates an approximate 4-fold increased prevalence of NSAID hypersensitivity among mastocytosis patients compared to the general population. However, most NSAID reactions were limited to the skin as the prevalence of overall anaphylaxis was infrequent. Our results support that mastocytosis patients with a known tolerance to NSAIDs can continue using these medications without special precautions, whereas those with a prior reaction to NSAIDs should undergo thorough allergy work-up, including drug challenges.
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Affiliation(s)
- Patrizia Bonadonna
- Allergy Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Francesco Olivieri
- Allergy Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Jesper Jarkvist
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Francesca Nalin
- Allergy Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Roberta Zanotti
- Hematology Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Laura Maclachlan
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Theo Gülen
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden,Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden,Correspondence: Theo Gülen
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