1. Medications and other factors that have a high probability of degranulating mast cells.

Things in this group should be avoided. If medications are deemed to be essential, medical supervision must be immediately at hand and emergency interventions immediately available.

• Anything to which the individual is known to be allergic.
• Venoms (snake, insect stings).
• Biologic compounds released by intestinal worms, jellyfish (on contact), ingested crayfish, and lobster.
• Dextran (used in some IV solutions and eye drops).
• Compound 48/80.
• Iodine-containing radiographic dyes.
• Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs).
• Scopolamine.
• Papaverine.
• Dipyridamole (anticoagulant).
• Thiamine.
• Trimethaphan.
• Narcotics: codeine, morphine, meperidine (pethidine, Demerol).
• Neuromuscular blocking agents:
     D-tubocurarine
     decamethonium
     gallamine
     metocurine
     pancuronium.
• Sympathomimetics (isoproterenol, amphetamine, ephedrine, phenylephrine).

2. Physical factors and medications that degranulate mast cells in most individuals with mastocytosis.

Things in this group should be approached carefully, under close supervision by a medically trained person, parent or caregiver who is prepared to administer emergency treatment if necessary.

• Exercise, heat, cold, friction, and sunlight.
• Alcohol.
• Polymyxin B.
• Amphotericin B.
• Quinine.
• Dextromethorphan.
• Local anesthetics: Lidocaine, tetracaine, procaine, methylparaben preservative.

3. Foods and additives that might degranulate mast cells in an individual with mastocytosis.

Things in this group should be approached carefully, using only a small amount at first, administered by a parent or caregiver who is prepared to administer treatment if needed.

• Hot foods.
• Spicy foods.
• Food preservatives.

4. Other factors:

• Emotional stress.
• Some bacterial and viral infections.

References:

The mast cell and mast cell disease; Jack Longley MD, Thomas P Duffy MD, and Steven Kohn MD; Journal of the American Academy of Dermatology 32; 4:545-561.

Treatment of mastocytosis: pharmacologic basis and current concepts; Gianni Marone, Giuseppe Spadaro, Francescopaolo Granata, Massimo Triggiani; Leukemia Research 25:583-594 (July, 2001).

Presentation of cutaneous mastocytosis in 173 children; Rodney Hannaford and Maureen Rogers; Australasian Journal of Dermatology (2001) 42:15-21.

Urticaria Pigmentosa: An Anesthetic Challenge Eric P Greenblatt MK, Linda Chen MD; J Clin Anesth 2:108-115 (1990).