Common Mast Cell Degranulation Triggers

While there is a large variability factor concerning things that cause the mast cells to degranulate in patients with pediatric mastocytosis, many triggers have been found to have a commonality among the general mastocytosis community and as such, it is wise to avoid these factors or to carefully monitor a child when such triggers cannot be avoided.

    Factors with a High Probability of Mast Cell Degranulation

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

    Anything the individual has previously reacted to

    Venom, coming from snakes and insects such as bees, wasps, and fire ants

    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---not commonly used, but with a high degranulation ability, all patients should stay aware

    Iodine-containing radiographic dyes

    Non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen

    Scopolamine: used in pre-operative procedures and in some eye drops

    Papaverine: found in some heart medications

    Dipyridamole: used as an anticoagulant

    Thiamine (vitamin B1):  found in vitamin supplements

    Trimethaphan: anticoagulant used in surgical procedures

    Narcotics: codeine, morphine, meperidine (pethidine, Demerol), and all derivatives

    Neuromuscular blocking agents:

       D-tubocurarine

       decamethonium

       gallamine

       metocurine

       pancuronium.

    Sympathomimetics: isoproterenol, amphetamine, ephedrine, phenylephrine

II.  Factors with a Common Probability of Mast Cell Degranulation

Factors 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. Reactions to these triggers may vary in degree of severity, so caution and supervision are consistently required.

    Extreme temperatures, heat or cold

    Sudden changes in temperature, such as entering a hot car, jumping into cold water, etc.

    Exercise and exertion

    Friction

    Alcohol: includes alcohol taken internally through food and medication and applied topically, such as hand sanitizer or wipe cleaners

    Polymyxin B: such as is found in many antibiotic ointments and some vaccines

    Dextromethorphan: found in cough suppressant medications

    Amphotericin B: commonly found in antifungal treatments

    Quinine: found in certain medications and in some tonic waters

    Local anesthetics: including lidocaine, tetracaine, procaine, methylparaben preservative

III. Factors with a Moderate Potential for Mast Cell Degranulation

Factors 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.

    Overly warm bath water

    Hot foods

    Spicy foods

    Preservatives and additives such as alcohols, MSG, sodium benzoate, and artificial colors.

IV. Factors that May Increase Mast Cell Activity

    Emotional stress and anxiety

    Sleep deprivation

    Pain

    Some bacterial and viral infections, including upper respiratory and urinary tract infections, bronchitis, pneumonia, and others

    Vaccinations-*Please note that Mastokids does not discourage or dissuade against routine and mandated vaccinations for children with mastocytosis. Mastokids suggests discussing with your health care provider the usefulness of antihistamine treatment before and/or after vaccinations are given.

 

References:

Castells, M., Metcalfe, D., & Escribano, L. (2011). Diagnosis and Treatment of Cutaneous Mastocytosis in Children. American Journal of Clinical Dermatology 12 (4), 259-270.

Greenblatt, M.K., & Chen, L. (1990). Urticaria Pigmentosa: An Anesthetic Challenge. J Clin Anesth 2, 108-115.

Hannaford, R. & Rogers, M. (2001). Presentation of Cutaneous Mastocytosis in 173 Children. Australasian Journal of Dermatology 42, 15-21.

Longley, J., Duffy, T.P., & Kohn, S. ( 1995) The mast cell and mast cell disease. Journal of the American Academy of Dermatology 32 (4), 545-561.

Marone, G., Spadar, G., Granata, F., & Triggiani, M. (2001) Treatment of mastocytosis: pharmacologic basis and current concepts. Leukemia Research 25, 583-594.