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 B6):  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.

For More Information Please Visit MastoKids/Degranular

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.