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Özdemir Ö, Kasımoğlu G, Bak A, Sütlüoğlu H, Savaşan S. Mast cell activation syndrome: An up-to-date review of literature. World J Clin Pediatr 2024; 13:92813. [DOI: 10.5409/wjcp.v13.i2.92813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/03/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
Mast cells are a subtype of white blood cells and are involved in the immune system. These cells contain many chemical substances called mediators, which are involved in the allergic response. The fact that mast cells play a role in many events that require urgent intervention, especially anaphylaxis, has led to a more detailed study of these cells. The diseases also caused by dysfunctions of mast cells have been examined in many circumstances. For instance, mast cell activation syndrome is known as an augmented number of cells due to decreased cell death, resulting in clinical symptoms affecting many systems. The main common symptoms include flushing, hypotension, urticaria, angioedema, headache, vomiting and diarrhea. Although the underlying mechanism is not yet clearly known, we aim to review the literature in a broad perspective and bring together the existing knowledge in the light of the literature due to the diversity of its involvement in the body and the fact that it is a little known syndrome.
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Affiliation(s)
- Öner Özdemir
- Department of Pediatric Allergy and Immunology, Sakarya University, Sakarya, Adapazarı 54100, Türkiye
| | - Gökçe Kasımoğlu
- Department of Pediatrics, Sakarya University, Sakarya, Adapazarı 54100, Türkiye
| | - Ayşegül Bak
- Department of Pediatrics, Sakarya University, Sakarya, Adapazarı 54100, Türkiye
| | - Hüseyin Sütlüoğlu
- Department of Pediatrics, Kocaeli City Hospital, Kocaeli 50123, Türkiye
| | - Süreyya Savaşan
- Department of Pediatrics, Children’s Hospital of Michigan, Hematology/Oncology, Central Michigan University College of Medicine, Mount Pleasant, MI 48859, United States
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI 12345, United States
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Woestemeier A, Semaan A, Block A, Arensmeyer J, Dohmen J, Kania A, Verrel F, Mücke M, Kalff JC, Lingohr P. Prognostic factors for the long term outcome after surgical celiac artery decompression in MALS. Orphanet J Rare Dis 2023; 18:334. [PMID: 37872625 PMCID: PMC10594872 DOI: 10.1186/s13023-023-02952-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The median arcuate ligament syndrome (MALS) is a rare disease caused by compression of the celiac artery (ORPHA: 293208). Surgical treatment of MALS aims to restore normal celiac blood flow by laparoscopic celiac artery decompression. However, surgical success rates vary widely between patients, therefore adequate selection of patients is essential to improve surgical outcome. Symptoms of MALS might also overlap with other chronic multi-system disorders such as mast cell activation syndrome (MCAS). So far, no clinical or radiological parameter was found to be predictive of the postoperative outcome. We, therefore, aim to study preclinical parameters in one of the largest MALS cohorts with the focus to identify patients that would benefit from surgical MAL release. RESULTS By analyzing 20 MALS patients that underwent surgical celiac artery decompression, we found 60% of patients (12/20) had a postoperative relief of their symptoms and a simultaneous decrease of analgetic use. No demographic, radiologic or operative parameter was able to predict postoperative symptom relief. However, mast cell activation syndrome correlated significantly (p = 0.04) with persistent symptoms after the operation. CONCLUSIONS Overall, laparoscopic MAL release can provide immediate symptomatic relief. Despite the missing predictive value of demographic and imaging data, our data show a correlation between persistent symptoms and a co-existing mast cell activation syndrome. This suggests that MCAS symptoms might be interpreted as MALS symptoms in the presence of celiac artery stenosis and therefore surgical treatment should be evaluated carefully. Overall, the selection of patients who are most likely to respond to surgical MAL release may best be accomplished by an interdisciplinary team of gastroenterologists, radiologists and surgeons.
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Affiliation(s)
- Anna Woestemeier
- Department for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany.
| | - Alexander Semaan
- Department for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Andreas Block
- Department for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Jan Arensmeyer
- Department for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Jonas Dohmen
- Department for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Alexander Kania
- Department for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Frauke Verrel
- Department for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Martin Mücke
- Institute for Digitalization and General Medicine, University Hospital Aachen, Aachen, Germany
- Center for Rare Diseases Aachen (ZSEA), University Hospital Aachen, Aachen, Germany
| | - Jörg C Kalff
- Department for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Philipp Lingohr
- Department for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
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Schmidt TJ, Sellin J, Molderings GJ, Conrad R, Mücke M. Health-related quality of life and health literacy in patients with systemic mastocytosis and mast cell activation syndrome. Orphanet J Rare Dis 2022; 17:295. [PMID: 35906626 PMCID: PMC9336039 DOI: 10.1186/s13023-022-02439-x] [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: 08/12/2021] [Accepted: 07/14/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Systemic mastocytosis is a rare genetic disease characterized by aberrant proliferation and/or activation of mast cells, resulting in multi-organ, allergy-like symptoms. Mast cell activation syndrome (MCAS) is a clinically similar, but more prevalent disease with unclear etiology. In this study, the health-related quality of life (HRQOL) and health literacy of people suffering from SM and MCAS were assessed. RESULTS Two validated questionnaires (QLQ-C30/QLQ-INFO25) from the European Organisation for Research and Treatment of Cancer (EORTC) were used to analyze HRQOL and level of information of SM and MCAS patients. In addition, a control group without any health issues was included. Data were analyzed by ANOVA and linear regression to detect significant differences. Questionnaire data from 66 patients with MCAS (83% female, mean 44 years), 32 patients with SM (78% female, mean 53 years) and 52 healthy participants (67% female, mean 48 years) resident in Germany were analyzed. HRQOL as measured by the Global health status was significantly worse in patients suffering from MCAS or SM compared to control group. Individuals with MCAS showed a slightly, but insignificantly lower score on Global health status, and a significantly lower score with respect to role function and fatigue. Patients with the rare disease SM felt significantly better informed on their disease compared to MCAS patients. Linear regression performed separately for both groups showed a direct influence of the level of information on patients' HRQOL. CONCLUSION Overall, our study showed a significant negative impact on the HRQOL of both diseases, but only a small difference in quality of life and severity of symptoms between patients with MCAS and the supposedly more severe form, the rare disease SM. Our results demonstrate that the level of information patients receive impacts HRQOL, and that this is not only an issue in rare diseases, but also diseases with unclear etiology and pathology. Our data shows that even slight improvements in the patient's level of information can have a positive effect on their quality of life, further highlighting the importance of gaining more knowledge on rare and incompletely understood diseases and communicating these insights to patients.
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Affiliation(s)
- Tobias Jürgen Schmidt
- grid.15090.3d0000 0000 8786 803XCenter for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Bonn, Germany
| | - Julia Sellin
- grid.412301.50000 0000 8653 1507Institute for Digitalization and General Practice, University Hospital Aachen, Aachen, Germany ,grid.412301.50000 0000 8653 1507Center for Rare Diseases Aachen (ZSEA), University Hospital Aachen, Aachen, Germany
| | - Gerhard J. Molderings
- grid.15090.3d0000 0000 8786 803XInstitute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Rupert Conrad
- grid.15090.3d0000 0000 8786 803XDepartment of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany ,Department of Psychosomatic Medicine and Psychotherapy, Münster, Germany
| | - Martin Mücke
- Institute for Digitalization and General Practice, University Hospital Aachen, Aachen, Germany. .,Center for Rare Diseases Aachen (ZSEA), University Hospital Aachen, Aachen, Germany.
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[Cystic diseases in urology : Recommendations for patients with systemic mast cell disease]. Urologe A 2022; 61:1115-1121. [PMID: 35508639 DOI: 10.1007/s00120-022-01841-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
Abstract
The systemic mast cell disease (MCAD; prevalence 17%) may occur frequently in urological patients. MCAD-induced changes include cysts in all organs, also in the urogenital system. In the presence of MCAD, the surgical removal of such cysts must consider specific features of the MCAD in order to reduce surgical and complication risks. Vice versa, if in urological examinations multiple cysts are found, this could be an indication of a possibly existing, in some circumstances, unrecognized MCAD.
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Landy RE, Stross WC, May JM, Kaleem TA, Malouff TD, Waddle MR, Vallow LA. Idiopathic mast cell activation syndrome and radiation therapy: a case study, literature review, and discussion of mast cell disorders and radiotherapy. Radiat Oncol 2019; 14:222. [PMID: 31818306 PMCID: PMC6902562 DOI: 10.1186/s13014-019-1434-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/02/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Mast Cell Activation Syndrome (MCAS) is classified as an idiopathic mast cell disorder where inconsistent or unknown triggers release inflammatory mediators and cause a constellation of symptoms. Studies demonstrate mast cells increase histamine, tryptase, and inflammatory cytokine expression following ionizing radiation. Additionally, there are cases of cutaneous mastocytosis developing within the initial radiation field suggesting mast cells play a role in local tissue reactions. Literature is sparse on radiation induced toxicity in patients with mast cell disorders. CASE PRESENTATION A 62 year old female patient with a history of MCAS received breast conservation therapy for invasive lobular carcinoma of the left breast initially AJCC 7th Stage IIB, pT3 pN0 M0. The patient underwent external beam radiotherapy (EBRT) and received 4500 cGy to the left whole breast, followed by a 1000 cGy boost to the lumpectomy cavity. She developed grade 1 radiation dermatitis. Two years later she progressed distantly and received stereotactic body radiation therapy to a lumbar vertebrae lesion to a dose of 2400 cGy in a single fraction. She developed no in-field dermatologic or systemic flare in her MCAS symptoms during radiation therapy. CONCLUSIONS To our knowledge there are no reported cases in the literature of patients diagnosed with MCAS or other idiopathic mast cell disorders undergoing radiation therapy. Idiopathic mast cell disorders such as MCAS and primary mast cell disorders alike should not be considered a contraindication to treatment with EBRT. This patient population appears to tolerate treatment without systemic flares in symptoms.
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Affiliation(s)
- Robin E Landy
- Florida State University College of Medicine, 1115 W Call St, Tallahassee, FL, 32304, USA
| | - William C Stross
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA.
| | - Jackson M May
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - Tasneem A Kaleem
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - Timothy D Malouff
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - Mark R Waddle
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - Laura A Vallow
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
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Sido B, Homann J, Hertfelder HJ, Zienkiewicz T, Christians KP, Schablin P, Mücke M, Molderings GJ. [Surgical interventions in patients with systemic mast cell activation disease : Recommendations for perioperative management]. Chirurg 2019; 90:548-556. [PMID: 30874862 DOI: 10.1007/s00104-019-0935-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Systemic mast cell activation disease (MCAD, prevalence 5-10%) is a multifactorial, polygenic disease with multisystemic symptoms that is characterized by an unregulated increased release of mast cell mediators and an accumulation of activated mast cells potentially in all organs and tissues. Due to the high prevalence of the disease, physicians involved in surgical, anesthesiological and interventional procedures are often unknowingly faced with MCAD patients experiencing unexpected preoperative, intraoperative and postoperative complications, if no mast cell-specific treatment regimens have been applied. OBJECTIVE The findings from a literature search, consensus recommendations of the various international expert groups and extensive own experience in the treatment of MCAD patients enable an empirical and evidence-based care of MCAD patients in association with invasive procedures. RESULTS AND CONCLUSION Due to the high prevalence of MCAD in the population, it can be assumed that patients with MCAD are correspondingly frequently represented in the surgical patient collective. When MCAD-specific peculiarities are preventively considered in the anesthesiological and surgical procedures in patients with proven or suspected mast cell disease, MCAD patients should not be classified as being at risk.
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Affiliation(s)
- B Sido
- Abteilung für Allgemein- und Viszeralchirurgie, Haus St. Elisabeth, Gemeinschaftskrankenhaus Bonn, Bonn, Deutschland
| | - J Homann
- Abteilung für Innere Medizin, Haus St. Elisabeth, Gemeinschaftskrankenhaus Bonn, Bonn, Deutschland
| | - H-J Hertfelder
- Institut für Experimentelle Hämatologie & Transfusionsmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - T Zienkiewicz
- Institut für Pathologie Bonn-Duisdorf, Bonn, Deutschland
| | - K-P Christians
- Anästhesie, Intensiv- und Schmerzmedizin, Gemeinschaftskrankenhaus Bonn, Bonn, Deutschland
| | - P Schablin
- Anästhesie, Intensiv- und Schmerzmedizin, Gemeinschaftskrankenhaus Bonn, Bonn, Deutschland
| | - M Mücke
- Zentrum für Seltene Erkrankungen Bonn (ZSEB), Universitätsklinikum Bonn, Bonn, Deutschland
| | - G J Molderings
- Institut für Humangenetik, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
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Molderings GJ, Haenisch B, Brettner S, Homann J, Menzen M, Dumoulin FL, Panse J, Butterfield J, Afrin LB. Pharmacological treatment options for mast cell activation disease. Naunyn Schmiedebergs Arch Pharmacol 2016; 389:671-94. [PMID: 27132234 PMCID: PMC4903110 DOI: 10.1007/s00210-016-1247-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 04/11/2016] [Indexed: 12/20/2022]
Abstract
Mast cell activation disease (MCAD) is a term referring to a heterogeneous group of disorders characterized by aberrant release of variable subsets of mast cell (MC) mediators together with accumulation of either morphologically altered and immunohistochemically identifiable mutated MCs due to MC proliferation (systemic mastocytosis [SM] and MC leukemia [MCL]) or morphologically ordinary MCs due to decreased apoptosis (MC activation syndrome [MCAS] and well-differentiated SM). Clinical signs and symptoms in MCAD vary depending on disease subtype and result from excessive mediator release by MCs and, in aggressive forms, from organ failure related to MC infiltration. In most cases, treatment of MCAD is directed primarily at controlling the symptoms associated with MC mediator release. In advanced forms, such as aggressive SM and MCL, agents targeting MC proliferation such as kinase inhibitors may be provided. Targeted therapies aimed at blocking mutant protein variants and/or downstream signaling pathways are currently being developed. Other targets, such as specific surface antigens expressed on neoplastic MCs, might be considered for the development of future therapies. Since clinicians are often underprepared to evaluate, diagnose, and effectively treat this clinically heterogeneous disease, we seek to familiarize clinicians with MCAD and review current and future treatment approaches.
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Affiliation(s)
- Gerhard J Molderings
- Institute of Human Genetics, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.
| | - Britta Haenisch
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Stefan Brettner
- Department of Oncology, Hematology and Palliative Care, Kreiskrankenhaus Waldbröl, Waldbröl, Germany
| | - Jürgen Homann
- Allgemeine Innere Medizin, Gastroenterologie und Diabetologie, Gemeinschaftskrankenhaus, Bonn, Germany
| | - Markus Menzen
- Allgemeine Innere Medizin, Gastroenterologie und Diabetologie, Gemeinschaftskrankenhaus, Bonn, Germany
| | - Franz Ludwig Dumoulin
- Allgemeine Innere Medizin, Gastroenterologie und Diabetologie, Gemeinschaftskrankenhaus, Bonn, Germany
| | - Jens Panse
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Joseph Butterfield
- Program for the Study of Mast Cell and Eosinophil Disorders, Mayo Clinic, Rochester, MN, 55905, USA
| | - Lawrence B Afrin
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, 55455, USA
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