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Cui A, Zhang J, Liu Z, Mu X, Zhong X, Xu H, Shan G. Patterned Au@Ag nanoarrays with electrically stimulated laccase-mimicking activity for dual-mode detection of epinephrine. Talanta 2024; 272:125821. [PMID: 38412753 DOI: 10.1016/j.talanta.2024.125821] [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: 11/10/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 02/29/2024]
Abstract
Epinephrine (EP) is a crucial neurotransmitter in the central nervous system. However, an abnormal level of EP in biological fluids can lead to various diseases. Therefore, it is essential to rapidly and accurately detect EP content. Herein, electrically stimulated patterned Au@Ag nanoarrays with laccase-mimicking activity were designed for the dual-mode detection of EP concentration. The patterned Au@Ag nanoarrays exhibit excellent electrochemical properties and electrically stimulated laccase-mimicking activity. They provide sensitive electrochemical responses for detecting EP content. Simultaneously, the Au@Ag nanoarrays can catalyze the oxidation of EP, enabling its detection through a colorimetric process. This dual-mode approach achieves the detection of EP content over a wide linear range of 0.5-200 μM, with a low detection limit of 0.152 μM. Furthermore, the utility of these nanoarrays for sensing EP in human serum was evaluated. This work provides a convenient method using patterned nanozyme array for the visible, rapid and accurate detection of EP content. It provides the important implication for the development of portable and reliable on-site analytical instruments.
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Affiliation(s)
- Anni Cui
- Centre for Advanced Optoelectronic Functional Materials Research, Key Laboratory for UV Light-Emitting Materials and Technology of the Ministry of Education, Northeast Normal University, Changchun, 130024, China
| | - Jialu Zhang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, 130041, China
| | - Zhifei Liu
- High School Attached to Northeast Normal University International Division, Changchun, 130021, China
| | - Xin Mu
- Centre for Advanced Optoelectronic Functional Materials Research, Key Laboratory for UV Light-Emitting Materials and Technology of the Ministry of Education, Northeast Normal University, Changchun, 130024, China
| | - Xiahua Zhong
- Centre for Advanced Optoelectronic Functional Materials Research, Key Laboratory for UV Light-Emitting Materials and Technology of the Ministry of Education, Northeast Normal University, Changchun, 130024, China
| | - Haitao Xu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, 130041, China.
| | - Guiye Shan
- Centre for Advanced Optoelectronic Functional Materials Research, Key Laboratory for UV Light-Emitting Materials and Technology of the Ministry of Education, Northeast Normal University, Changchun, 130024, China.
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Rydz A, Lange M, Ługowska-Umer H, Sikorska M, Nowicki RJ, Morales-Cabeza C, Alvarez-Twose I. Diffuse Cutaneous Mastocytosis: A Current Understanding of a Rare Disease. Int J Mol Sci 2024; 25:1401. [PMID: 38338679 DOI: 10.3390/ijms25031401] [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: 12/01/2023] [Revised: 01/06/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
Mastocytosis is a heterogeneous disease characterized by the expansion and accumulation of neoplastic mast cells in various tissues. Diffuse cutaneous mastocytosis (DCM) is a rare and most severe form of cutaneous mastocytosis, which typically occurs in childhood. There have been reports of a familial DCM with specific gene mutations, indicating both sporadic and hereditary factors involved in its pathogenesis. DCM is associated with severe MC mediator-related symptoms and an increased risk of anaphylaxis. The diagnosis is based on the appearance of skin lesions, which typically show generalized thickening, erythroderma, blistering dermographism, and a positive Darier's sign. Recognition, particularly in infants, is challenging due to DCMs resemblance to other bullous skin disorders. Therefore, in unclear cases, a skin biopsy is crucial. Treatment focuses on symptom management, mainly including antihistamines and mast cell stabilizers. In extremely severe cases, systemic steroids, tyrosine kinase inhibitors, phototherapy, or omalizumab may be considered. Patients should be equipped with an adrenaline autoinjector. Herein, we conducted a comprehensive review of literature data on DCM since 1962, which could help to better understand both the management and prognosis of DCM, which depends on the severity of skin lesions, intensity of mediator-related symptoms, presence of anaphylaxis, and treatment response.
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Affiliation(s)
- Agnieszka Rydz
- Student's Scientific Circle Practical and Experimental Dermatology, Medical University of Gdansk, 80-211 Gdańsk, Poland
| | - Magdalena Lange
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Hanna Ługowska-Umer
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Monika Sikorska
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Roman J Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Cristina Morales-Cabeza
- Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast)-Spanish Reference Center for Mastocytosis, Hospital Virgen del Valle-Complejo Hospitalario Universitario de Toledo, 45071 Toledo, Spain
| | - Iván Alvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast)-Spanish Reference Center for Mastocytosis, Hospital Virgen del Valle-Complejo Hospitalario Universitario de Toledo, 45071 Toledo, Spain
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3
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Brockow K, Bent RK, Schneider S, Spies S, Kranen K, Hindelang B, Kurgyis Z, Broesby-Olsen S, Biedermann T, Grattan CE. Challenges in the Diagnosis of Cutaneous Mastocytosis. Diagnostics (Basel) 2024; 14:161. [PMID: 38248039 PMCID: PMC10814739 DOI: 10.3390/diagnostics14020161] [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: 11/20/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Mastocytosis is characterized by an accumulation of clonal mast cells (MCs) in tissues such as the skin. Skin lesions in mastocytosis may be clinically subtle or heterogeneous, and giving the correct diagnosis can be difficult. METHODS This study compiles personal experiences together with relevant literature, discussing possible obstacles encountered in diagnosing skin involvement in mastocytosis and cutaneous mastocytosis (CM). RESULTS The nomenclature of the term "CM" is ambiguous. The WHO classification defines CM as mastocytosis solely present in the skin. However, the term is also used as a morphological description, e.g., in maculopapular cutaneous mastocytosis (MPCM). This is often seen in systemic, as well as cutaneous, mastocytosis. Typical CM manifestations (MPCM), including mastocytoma or diffuse cutaneous mastocytosis (DCM), all share a positive Darier's sign, and can thus be clinically recognized. Nevertheless, distinguishing monomorphic versus polymorphic MPCM may be challenging, even for experienced dermatologists. Less typical clinical presentations, such as MPCM with telangiectatic erythemas (formerly called telangiectasia macularis eruptiva perstans), confluent, nodular or xanthelasmoid variants may require a skin biopsy for histopathological confirmation. Because MC numbers in CM have a large overlap to those in healthy and inflamed skin, detailed histopathological criteria to diagnose mastocytosis in MPCM are needed and have been proposed. D816V KIT mutational analysis in tissue is helpful for confirming the diagnosis. Biomarkers allow the prediction of the course of CM into regression or evolution of the disease. Further diagnostic measures should screen for concomitant diseases, such as malignant melanoma, and for systemic involvement. CONCLUSIONS Whereas in typical cases the diagnosis of CM may be uncomplicated, less typical manifestations may require specific investigations for making the diagnosis and predicting its course.
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Affiliation(s)
- Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, 80802 Munich, Germany (T.B.)
- Department of Dermatology and Allergy Centre, Odense University Hospital, 5000 Odense, Denmark
| | - Rebekka Karolin Bent
- Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, 80802 Munich, Germany (T.B.)
| | - Simon Schneider
- Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, 80802 Munich, Germany (T.B.)
| | - Sophie Spies
- Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, 80802 Munich, Germany (T.B.)
| | - Katja Kranen
- Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, 80802 Munich, Germany (T.B.)
| | - Benedikt Hindelang
- Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, 80802 Munich, Germany (T.B.)
| | - Zsuzsanna Kurgyis
- Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, 80802 Munich, Germany (T.B.)
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense University Hospital, 5000 Odense, Denmark
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, 80802 Munich, Germany (T.B.)
| | - Clive E. Grattan
- St John’s Institute of Dermatology, Guy’s Hospital, London SE1 9RT, UK
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Conner JE, Steinberg JA. Approach to Idiopathic Anaphylaxis in Adolescents. Med Clin North Am 2024; 108:123-155. [PMID: 37951646 DOI: 10.1016/j.mcna.2023.05.018] [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] [Indexed: 11/14/2023]
Abstract
Anaphylaxis is a potentially-life threatening condition. Adolescents are particularly vulnerable due to increased risk-taking behaviors, poor disease management, and minimized perception of risk. Although most anaphylaxis can be attributed to food, drug, or venom allergy via a detailed history and confirmatory studies, in nearly 1 in 5 cases, the cause may not be obvious. Clinical differentials including rare allergens, cofactors, mast-cell disorders, and mimic disorders can increase the likelihood of discovering of the cause of anaphylaxis.
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Affiliation(s)
- Jeanne E Conner
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, 9000 West Wisconsin Avenue. B440, Milwaukee, WI 53226, USA
| | - Joshua A Steinberg
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, 9000 West Wisconsin Avenue. B440, Milwaukee, WI 53226, USA; Section of Allergy, Department of Medicine, Clement J. Zablocki Veterans' Affairs Medical Center, 5000 West National Avenue, 1AN, Milwaukee, WI 53295, USA.
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5
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Almheiri SK, Pakran J, AlFalasi AA, El Bahtimi R. Bullous Mastocytosis: A Rare Variant of Diffuse Cutaneous Mastocytosis. Cureus 2024; 16:e51660. [PMID: 38313964 PMCID: PMC10838141 DOI: 10.7759/cureus.51660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
Mastocytosis is a disease of the mast cells caused by an increase in the number of mast cells due to abnormal proliferation. The disease is associated with a mutation in the c-kit gene, which is a key factor in the development of mast cells. Mastocytosis is classified into two main groups, namely, cutaneous and systemic mastocytosis, based on the site of mast cell accumulation. In cutaneous mastocytosis, the cells purely gather in the skin. In contrast, systemic mastocytosis must affect an internal organ, including the bone marrow, lymph nodes, liver, spleen, and/or the gastrointestinal tract with or without skin involvement. Cutaneous mastocytosis has four distinct presentations, including urticaria pigmentosa, cutaneous mastocytoma, diffuse cutaneous mastocytosis, and telangiectasia macularis eruptive perstans listed from most to least common. This case report presents a rare bullous variant of diffuse cutaneous mastocytosis.
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Affiliation(s)
| | - Jaheersha Pakran
- Dermatology, Dubai Academic Health Corporation (Dubai Health), Dubai, ARE
| | | | - Reem El Bahtimi
- Dermatopathology, International Dermpath Consult, Dubai, ARE
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6
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Patel K, Cuervo-Pardo L, Cresoe S, Cavero-Chavez V. An Unusual Transition from Cutaneous to Systemic Mastocytosis in a Pediatric Patient. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2023; 36:150-152. [PMID: 38134319 DOI: 10.1089/ped.2023.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Background: Cutaneous mastocytosis (CM) occurs when abnormal mast cells accumulate in the skin, whereas in systemic mastocytosis (SM), accumulation also occurs in other tissues. A transition from CM to SM is an atypical occurrence in pediatric patients. Case Presentation: An 8-month-old female presented with a 3-month history of whole body hyperpigmented macules with a normal serum tryptase level, consistent with a diagnosis of CM. At age 2.5 years, cutaneous lesions increased and repeat serum tryptase levels were elevated. Subsequent positive peripheral blood KIT D816V mutation testing furthered concern for a monoclonal mast cell disorder; therefore, prompting a bone marrow biopsy which was consistent with a diagnosis of SM. Conclusion: Our case depicts the possible transition from CM to SM in a pediatric patient. Despite an initial presentation consistent with a diagnosis of CM, watchful monitoring for signs and symptoms indicative of systemic involvement may be warranted in some pediatric patients.
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Affiliation(s)
- Keval Patel
- Department of Medicine, University of Florida Gainesville, Florida, USA
| | - Lyda Cuervo-Pardo
- Department of Pediatrics, University of Florida Gainesville, Florida, USA
| | - Samantha Cresoe
- Division of Rheumatology, Allergy and Clinical Immunology, Department of Medicine, University of Florida Gainesville, Florida, USA
| | - Vanessa Cavero-Chavez
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Florida Gainesville, Florida, USA
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7
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Chantran Y, Valent P, Arock M. KIT Mutations and Other Genetic Defects in Mastocytosis: Implications for Disease Pathology and Targeted Therapies. Immunol Allergy Clin North Am 2023; 43:651-664. [PMID: 37758404 DOI: 10.1016/j.iac.2023.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
A KIT activating mutation (usually KIT D816V) is detected in neoplastic cells in greater than 90% of indolent patients with systemic mastocytosis (SM). In more advanced variants of SM, additional genetic defects can be found in several myeloid malignancy-related genes, which can be detected by applying next-generation sequencing. Currently, the techniques recommended to detect the KIT D816V mutation and quantify the mutational burden in peripheral blood, bone marrow, or other organs/tissues are allele specific-quantitative PCR or droplet digital PCR. These techniques are useful for diagnosis, prognostication, follow-up and monitoring of therapeutic efficacy of cytoreductive agents in patients with SM.
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Affiliation(s)
- Yannick Chantran
- Department of Biological Hematology, Pitié-Salpêtrière Hospital, DMU BioGem, AP-HP.Sorbonne University, Paris, France; Department of Biological Immunology, Saint-Antoine Hospital, DMU BioGem, AP-HP.Sorbonne University, Paris, France; Health Environmental Risk Assessment (HERA) Team, Centre of Research in Epidemiology and Statistics (CRESS), Inserm / INRAE, Faculty of Pharmacy, Université de Paris, Paris, France
| | - Peter Valent
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Austria; Division of Hematology and Hemostaseology, Department of Internal Medicine, Medical University of Vienna
| | - Michel Arock
- Department of Biological Hematology, Pitié-Salpêtrière Hospital, DMU BioGem, AP-HP.Sorbonne University, Paris, France; Department of Biological Hematology, Pitié-Salpêtrière Hospital, DMU BioGem, AP-HP.Sorbonne University, Paris, France.
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8
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Renke J, Irga-Jaworska N, Lange M. Pediatric and Hereditary Mastocytosis. Immunol Allergy Clin North Am 2023; 43:665-679. [PMID: 37758405 DOI: 10.1016/j.iac.2023.04.001] [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] [Indexed: 10/03/2023]
Abstract
To a large extent, the clinical picture of pediatric mastocytosis depends on the age at which it is diagnosed. A neonate with diffuse cutaneous mastocytosis may frequently present in a severe state requiring treatment. Toddlers may require long-term anti-mediator therapy, and this may lead to concerns such as organizing preschool education due to the need for epinephrine injections. A teenager may have to face cutaneous disease persistence or a diagnosis of systemic mastocytosis. Further studies are needed to refine the available treatment options and prognosis for different age groups.
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Affiliation(s)
- Joanna Renke
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdańsk, ul. Skłodowskiej-Curie 3A, 80-210 Gdańsk.
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdańsk, ul. Skłodowskiej-Curie 3A, 80-210 Gdańsk
| | - Magdalena Lange
- Department of Dermatology, Venerology and Allergology, Medical University of Gdańsk, ul. Skłodowskiej-Curie 3A, 80-210 Gdańsk
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9
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Kaszuba A, Sławińska M, Żółkiewicz J, Sobjanek M, Nowicki RJ, Lange M. Mastocytosis and Skin Cancer: The Current State of Knowledge. Int J Mol Sci 2023; 24:9840. [PMID: 37372988 DOI: 10.3390/ijms24129840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Mastocytosis is a heterogeneous group of diseases associated with excessive proliferation and accumulation of mast cells in different organs. Recent studies have demonstrated that patients suffering from mastocytosis face an increased risk of melanoma and non-melanoma skin cancer. The cause of this has not yet been clearly identified. In the literature, the potential influence of several factors has been suggested, including genetic background, the role of cytokines produced by mast cells, iatrogenic and hormonal factors. The article summarizes the current state of knowledge regarding the epidemiology, pathogenesis, diagnosis, and management of skin neoplasia in mastocytosis patients.
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Affiliation(s)
- Agnieszka Kaszuba
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Smoluchowskiego Street 17, 80-214 Gdańsk, Poland
| | - Martyna Sławińska
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Smoluchowskiego Street 17, 80-214 Gdańsk, Poland
| | - Jakub Żółkiewicz
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Smoluchowskiego Street 17, 80-214 Gdańsk, Poland
| | - Michał Sobjanek
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Smoluchowskiego Street 17, 80-214 Gdańsk, Poland
| | - Roman J Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Smoluchowskiego Street 17, 80-214 Gdańsk, Poland
| | - Magdalena Lange
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Smoluchowskiego Street 17, 80-214 Gdańsk, Poland
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10
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Wassmer H, Hartmann K. [Mastocytosis in children]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:323-329. [PMID: 37140636 PMCID: PMC10169881 DOI: 10.1007/s00105-023-05168-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Mastocytosis in children is a rare disease characterized by an abnormal accumulation of tissue mast cells. Mastocytosis in children presents with typical skin alterations that are classified as maculopapular cutaneous mastocytosis, diffuse cutaneous mastocytosis, or mastocytoma. Some patients also develop mast cell mediator symptoms, such as pruritus, flush, and anaphylaxis. In many children, the disease is characterized by a benign and usually self-limiting course; systemic mastocytosis with extracutaneous involvement and a chronic or progressive course is found only rarely. Therapeutically, H1 antihistamines are primarily used on an as-needed basis or as continuous treatment, depending on the severity. Children, parents and caregivers should be thoroughly educated about the clinical picture and possible trigger factors of mast cell mediator release. For children with extensive skin alterations and severe symptoms, the prescription of an epinephrine auto-injector is recommended for emergency treatment.
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Affiliation(s)
- Hanna Wassmer
- Allergologische Poliklinik, Klinik für Dermatologie, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz
| | - Karin Hartmann
- Allergologische Poliklinik, Klinik für Dermatologie, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz.
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11
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Woźniak E, Owczarczyk-Saczonek A, Lange M, Czarny J, Wygonowska E, Placek W, Nedoszytko B. The Role of Mast Cells in the Induction and Maintenance of Inflammation in Selected Skin Diseases. Int J Mol Sci 2023; 24:ijms24087021. [PMID: 37108184 PMCID: PMC10139379 DOI: 10.3390/ijms24087021] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/23/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Under physiological conditions, skin mast cells play an important role as guardians that quickly react to stimuli that disturb homeostasis. These cells efficiently support, fight infection, and heal the injured tissue. The substances secreted by mast cells allow for communication inside the body, including the immune, nervous, and blood systems. Pathologically non-cancerous mast cells participate in allergic processes but also may promote the development of autoinflammatory or neoplastic disease. In this article, we review the current literature regarding the role of mast cells in autoinflammatory, allergic, neoplastic skin disease, as well as the importance of these cells in systemic diseases with a pronounced course with skin symptoms.
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Affiliation(s)
- Ewelina Woźniak
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, The University of Warmia and Mazury, 10-229 Olsztyn, Poland
| | - Agnieszka Owczarczyk-Saczonek
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, The University of Warmia and Mazury, 10-229 Olsztyn, Poland
| | - Magdalena Lange
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-214 Gdansk, Poland
| | - Justyna Czarny
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-214 Gdansk, Poland
| | - Ewa Wygonowska
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, The University of Warmia and Mazury, 10-229 Olsztyn, Poland
| | - Waldemar Placek
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, The University of Warmia and Mazury, 10-229 Olsztyn, Poland
| | - Bogusław Nedoszytko
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-214 Gdansk, Poland
- Invicta Fertility and Reproductive Centre, Molecular Laboratory, 81-740 Sopot, Poland
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12
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Tiano R, Krase IZ, Sacco K. Updates in diagnosis and management of paediatric mastocytosis. Curr Opin Allergy Clin Immunol 2023; 23:158-163. [PMID: 36730855 DOI: 10.1097/aci.0000000000000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Paediatric mastocytosis is a rare clonal disorder characterized by the overproduction and organ infiltration of mast cells. Symptoms are due to mast cell mediator release. Cutaneous mastocytosis is the most common presentation in children with systemic disease being rare. Our aim is to provide a practical guideline in differentiating subtypes of paediatric mastocytosis while providing actionable recommendations on diagnosis, clinical management, follow-up and prognosis. RECENT FINDINGS Longitudinal cohort studies of paediatric cutaneous mastocytosis have shown spontaneous remission with favourable prognosis. Hereditary alpha-tryptasemia may coexist with mastocytosis; thus, screening for this disorder is recommended. There is an emerging role for serum tryptase in asthma endotyping and potential for using therapeutic tryptase inhibitors. SUMMARY Morbidity in paediatric mastocytosis typically arises from symptoms secondary to mast cell mediator release. Prognosis for nonaggressive disease is typically favourable; however, risks for anaphylaxis and psychosocial morbidity may be underestimated. Symptomatic management and anticipatory guidance may help support patients and families throughout the disease course.
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Affiliation(s)
- Rasa Tiano
- Division of Pulmonology, Section of Allergy-Immunology, Phoenix Children's Hospital, Phoenix
| | - Ifat Z Krase
- Division of Pulmonology, Section of Allergy-Immunology, Phoenix Children's Hospital, Phoenix
- Divison of Allergy-Immunology, Mayo Clinic, Scottsdale
| | - Keith Sacco
- Division of Pulmonology, Section of Allergy-Immunology, Phoenix Children's Hospital, Phoenix
- Department of Child Health, University of Arizona College of Medicine, Phoenix, Arizona, USA
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13
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Popadic S, Lalosevic J, Lekic B, Gajić-Veljic M, Bonaci-Nikolic B, Nikolic M. Mastocytosis in children: a single-center long-term follow-up study. Int J Dermatol 2023; 62:616-620. [PMID: 36807903 DOI: 10.1111/ijd.16612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/29/2022] [Accepted: 01/20/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Mastocytosis is a heterogeneous group of rare disorders characterized by the accumulation of clonal mast cells in organs such as the skin and bone marrow. The diagnosis of cutaneous mastocytosis (CM) is based on clinical findings, positive Darier's sign, and histopathology, if necessary. METHODS Medical records of 86 children with CM diagnosed during a 35-year long period were reviewed. Most patients (93%) developed CM during the first year of life (median age 3 months). Clinical features at presentation and during the follow-up period were analyzed. Baseline serum tryptase level was measured in 28 patients. RESULTS A total of 85% of patients had maculopapular cutaneous mastocytosis/urticaria pigmentosa (MPCM/UP), 9% had mastocytoma, and 6% had diffuse cutaneous mastocytosis (DCM). Boy to girl ratio was 1.1:1. Fifty-four of 86 patients (63%) were followed from 2 to 37 years (median 13 years). Complete resolution was registered in 14% of mastocytoma cases, 14% of MCPM/UP, and in 25% of DCM patients. After the age of 18, skin lesion persisted in 14% mastocytoma, 7% MCPM/UP, and 25% children with DCM. Atopic dermatitis was diagnosed in 9.6% of patients with MPCM/UP. Three of 28 patients had elevated serum tryptase. Prognosis in all patients was good, and there were no signs of progression to systemic mastocytosis (SM). CONCLUSION To the best of our knowledge, our results represent the longest single-center follow-up study of childhood-onset CM. We found no complications of massive mast cell degranulation or progression to SM.
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Affiliation(s)
- Svetlana Popadic
- Clinic of Dermatovenereology, University Clinical Center of Serbia, Belgrade, Serbia.,University of Belgrade School of Medicine, Belgrade, Serbia
| | - Jovan Lalosevic
- Clinic of Dermatovenereology, University Clinical Center of Serbia, Belgrade, Serbia.,University of Belgrade School of Medicine, Belgrade, Serbia
| | - Branislav Lekic
- Clinic of Dermatovenereology, University Clinical Center of Serbia, Belgrade, Serbia.,University of Belgrade School of Medicine, Belgrade, Serbia
| | - Mirjana Gajić-Veljic
- Clinic of Dermatovenereology, University Clinical Center of Serbia, Belgrade, Serbia.,University of Belgrade School of Medicine, Belgrade, Serbia
| | - Branka Bonaci-Nikolic
- University of Belgrade School of Medicine, Belgrade, Serbia.,Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milos Nikolic
- Clinic of Dermatovenereology, University Clinical Center of Serbia, Belgrade, Serbia.,University of Belgrade School of Medicine, Belgrade, Serbia
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14
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Bossi G, Brazzelli V, De Amici M, Pietra D, Raviola C, Naso M, Regalbuto C, Boselli F, Fortina V, Marseglia GL. Successful treatment with Omalizumab of a child affected by Systemic Mastocytosis: clinical and biological implications. Ital J Pediatr 2023; 49:6. [PMID: 36639823 PMCID: PMC9839392 DOI: 10.1186/s13052-022-01402-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/21/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Pediatric Mastocytosis is a rare and heterogeneous disease, characterized by accumulation of mast cells in the skin (Cutaneous Mastocytosis) and/or, less frequently, in other organs, mainly liver, spleen, bone marrow, lymph nodes and gastrointestinal tract (Systemic Mastocytosis). Patients affected by Systemic Mastocytosis show symptoms caused by a massive release of mast cell mediators: itching, flushing, abdominal pain, generalized weakness, fatigue and neuropsychiatric disorders. Moreover, children with Systemic Mastocytosis are at greater risk of anaphylactic/anaphylactoid reactions, often poorly controlled by the conventional therapy with antihistamines, mast cells stabilizers and steroids. As a result, children affected by Systemic Mastocytosis have a poor quality of life and suffer the consequence of prolonged steroidal treatment. CASE PRESENTATION A child with Systemic Mastocytosis and severe symptoms, refractory to symptomatic and steroidal therapy, has been successfully treated with Omalizumab, an anti-IgE monoclonal antibody usually employed in allergic patients with severe asthma and orticaria. The onset of clinical benefit of Omalizumab therapy was extraordinarily rapid, but proved to be strictly dependent on drug administration. The child has become completely and steadily asymptomatic. No other anaphylactic episodes have been reported. Steroid treatment could be definitively withdrawn after the second dose of Omalizumab, and all the other medications were later reduced. Twenty months after beginning, Omalizumab therapy is still ongoing with good symptomatology control; no side effects have been observed so far. CONCLUSIONS In our experience, Omalizumab is an effective treatment for children affected by Systemic Mastocytosis not responding to conventional medical treatments. The main strengths of this therapy are its rapid and extraordinary efficacy to control the severe mast cells mediator-related symptoms, the lack of side effects and its steroid-sparing effect. However, more extensive and controlled studies in pediatric patients affected by Systemic Mastocytosis are needed to substantiate these promising findings.
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Affiliation(s)
- Grazia Bossi
- grid.419425.f0000 0004 1760 3027Department of Pediatrics, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Viale Golgi n.19, 27100 Pavia, Italy
| | - Valeria Brazzelli
- grid.419425.f0000 0004 1760 3027Institute of Dermatology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Mara De Amici
- grid.419425.f0000 0004 1760 3027Immuno-Allergology Laboratory, Clinical Chemistry Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Daniela Pietra
- grid.419425.f0000 0004 1760 3027Department of Hematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Chiara Raviola
- grid.8982.b0000 0004 1762 5736Pediatric School of Specialization, University of Pavia, Pavia, Italy
| | - Matteo Naso
- grid.8982.b0000 0004 1762 5736Pediatric School of Specialization, University of Pavia, Pavia, Italy
| | - Corrado Regalbuto
- grid.8982.b0000 0004 1762 5736Pediatric School of Specialization, University of Pavia, Pavia, Italy
| | - Federica Boselli
- grid.8982.b0000 0004 1762 5736Pediatric School of Specialization, University of Pavia, Pavia, Italy
| | - Valeria Fortina
- grid.419425.f0000 0004 1760 3027Department of Hematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Gian Luigi Marseglia
- grid.419425.f0000 0004 1760 3027Department of Pediatrics, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Viale Golgi n.19, 27100 Pavia, Italy ,grid.8982.b0000 0004 1762 5736Department of Clinical-Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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15
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Swarnkar B, Sarkar R. Childhood Cutaneous Mastocytosis: Revisited. Indian J Dermatol 2023; 68:121. [PMID: 37151240 PMCID: PMC10162768 DOI: 10.4103/ijd.ijd_264_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Cutaneous mastocytosis is a neoplasm characterized by the proliferation and accumulation of mast cells in the skin. There can be involvement of other organ systems as well. Cutaneous manifestations can vary from mastocytoma to maculopapular lesions to diffuse cutaneous form. There can be symptoms associated with mast cell mediators release like itching, flushing, hypotension, diarrhoea, abdominal pain, and anaphylaxis. Hence, the mainstay of treatment is avoidance of triggers causing these mediators to release, anti-histamines, topical/intra-lesional/systemic steroids, mast cell-targeted therapy, epinephrine, and omalizumab depending upon the severity of symptoms/signs. Childhood cases usually have a good prognosis except in a few cases, especially those with systemic involvement. Such situations might warrant cytoreductive therapy, polychemotherapy, or autologous stem cell transplantation. Here, we intend to review the English literature on childhood cutaneous mastocytosis.
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Affiliation(s)
- Bhavya Swarnkar
- From the Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Sarkar
- Department of Dermatology, LHMC and Associated KSCH and SSK Hospital, New Delhi, India
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16
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How to evaluate the patient with a suspected mast cell disorder and how/when to manage symptoms. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:55-63. [PMID: 36485101 PMCID: PMC9820312 DOI: 10.1182/hematology.2022000366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Mast cell disorders include mastocytosis and mast cell activation syndromes. Mastocytosis is a rare clonal disorder of the mast cell, driven by KIT D816V mutation in most cases. Mastocytosis is diagnosed and classified according to World Health Organization criteria. Mast cell activation syndromes encompass a diverse group of disorders and may have clonal or nonclonal etiologies. Hematologists may be consulted to assist in the diagnostic workup and/or management of mast cell disorders. A consult to the hematologist for mast cell disorders may provoke anxiety due to the rare nature of these diseases and the management of nonhematologic mast cell activation symptoms. This article presents recommendations on how to approach the diagnosis and management of patients referred for common clinical scenarios.
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17
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Sławińska M, Kaszuba A, Lange M, Nowicki RJ, Sobjanek M, Errichetti E. Dermoscopic Features of Different Forms of Cutaneous Mastocytosis: A Systematic Review. J Clin Med 2022; 11:jcm11164649. [PMID: 36012900 PMCID: PMC9410418 DOI: 10.3390/jcm11164649] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/23/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
The term mastocytosis refers to a heterogeneous group of disorders characterised by accumulation of clonal mast cells in different organs, most commonly in the skin. Little is known about the role of dermoscopy in the diagnostics of mastocytosis. To date, no systematic review on the dermoscopic features of cutaneous mastocytosis has been performed. The aim of this study was to summarise the current knowledge in the field as well as to identify the knowledge gaps to show possible directions for further studies, based on a systematic search of PubMed, Scopus, and Web of Science databases and related references published before 3 January 2022. Dermoscopic features, type of dermoscope, polarisation mode, magnification, and number of cases were analysed. In total, 16 articles were included in this review (3 case series and 13 case reports), analysing 148 patients with different variants of cutaneous mastocytosis; all of the studies analysed had a low level of evidence (V). The main dermoscopic features of urticaria pigmentosa included brown structureless areas, brown lines arranged in a network, and linear vessels distributed in a reticular pattern, with this last finding also being typical of telangiectasia macularis eruptiva perstans. The presence of either circumscribed yellow structureless areas or diffuse yellowish background was a constant pattern of mastocytoma, while nodular, pseudoangiomatous xanthelasmoid, and plaque-type mastocytosis were typified by light-brown structureless areas and/or pigment network, though the first two variants also showed yellow/yellow-orange structureless areas. Finally, pigmented streaks of radial distribution surrounding hair follicles were described to be a pathognomonic dermoscopic feature of pseudoxanthomatous mastocytosis. Although this review shows that the various clinical forms of cutaneous mastocytosis may feature diagnostic dermoscopic clues, it also underlines the need for further investigation as several relevant data are missing, including evaluation of dermoscopic pattern according to anatomical locations or “lesion age”, studies on rare mastocytosis variants, evaluation of the prognostic role of dermoscopy in the context of systemic involvement, and comparative analyses with common clinical mimickers.
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Affiliation(s)
- Martyna Sławińska
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, 97-331 Gdańsk, Poland
- Correspondence:
| | - Agnieszka Kaszuba
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, 97-331 Gdańsk, Poland
| | - Magdalena Lange
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, 97-331 Gdańsk, Poland
| | - Roman J. Nowicki
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, 97-331 Gdańsk, Poland
| | - Michał Sobjanek
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, 97-331 Gdańsk, Poland
| | - Enzo Errichetti
- Department of Experimental and Clinical Medicine, Universita degli Studi di Udine, 33100 Udine, Italy
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18
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Jennings SV, Finnerty CC, Hobart JS, Martín-Martínez M, Sinclair KA, Slee VM, Agopian J, Akin C, Álvarez-Twose I, Bonadonna P, Bowman AS, Brockow K, Bumbea H, de Haro C, Fok JS, Hartmann K, Hegmann N, Hermine O, Kalisiak M, Katelaris CH, Kurz J, Marcis P, Mayne D, Mendoza D, Moussy A, Mudretzkyj G, Vaia NN, Niedoszytko M, Elberink HO, Orfao A, Radia DH, Rosenmeier S, Ribada E, Schinhofen W, Schwaab J, Siebenhaar F, Triggiani M, Tripodo G, Velazquez R, Wielink Y, Wimazal F, Yigit T, Zubrinich C, Valent P. Mast Cell Diseases in Practice and Research: Issues and Perspectives Raised by Patients and Their Recommendations to the Scientific Community and Beyond. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2039-2051. [PMID: 35777651 DOI: 10.1016/j.jaip.2022.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/08/2022] [Accepted: 06/20/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Since 2010, patients and physicians have collaborated to understand unmet needs of patients with mast cell diseases, incorporating mastocytosis and mast cell activation disorders, which include mast cell activation syndromes. OBJECTIVE This Open Innovation in Science project aims to expand understanding of the needs of patients affected by mast cell diseases, and encourage global communication among patient advocacy groups, physicians, researchers, industry, and government. A major aim is to support the scientific community's efforts to improve diagnosis, management, therapy, and patients' quality of life by addressing unmet needs. METHODS In collaboration with mast cell disease specialists, 13 patient advocacy groups from 12 countries and regions developed lists of top patient needs. A core team of leaders from patient advocacy groups collected and analyzed the data and proposed possible actions to address patient needs. RESULTS Findings identified similarities and differences among participating countries in unmet needs between patients with mastocytosis and those with mast cell activation syndromes. Issues emphasized struggles relating to the nature and rarity of mast cell diseases, their impact on quality of life, the diagnostic process, access to appropriate care, more effective treatment, and the need for research. CONCLUSIONS Solutions vary across countries because situations differ, in particular regarding the existence of and access to centers of excellence and reference centers. Multifaceted mast cell activation syndrome barriers necessitate innovative approaches to improve access to appropriate care. The outcomes of this project should greatly support scientists and clinicians in their efforts to improve diagnosis, management, and treatment of patients with mastocytosis and mast cell activation disorders.
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Affiliation(s)
- Susan V Jennings
- The Mast Cell Disease Society, Inc. (DBA The Mastocytosis Society, Inc.), Sterling, Mass.
| | - Celeste C Finnerty
- The Mast Cell Disease Society, Inc. (DBA The Mastocytosis Society, Inc.), Sterling, Mass; Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | | | - Mercedes Martín-Martínez
- Spanish Association of Mastocytosis and Related Diseases (AEDM), Madrid, Spain; Medicinal Chemistry Institute (IQM-CSIC), Madrid, Spain
| | - Kristin A Sinclair
- The Australasian Mastocytosis Society, Port Macquarie, New South Wales, Australia
| | - Valerie M Slee
- The Mast Cell Disease Society, Inc. (DBA The Mastocytosis Society, Inc.), Sterling, Mass
| | - Julie Agopian
- French Association for Research Initiatives on Mast Cells and Mastocytosis (AFIRMM), Paris, France
| | - Cem Akin
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Michigan, Ann Arbor, Mich
| | - Ivan Álvarez-Twose
- Institute of Mastocytosis Studies of Castilla-La Mancha (CLMast) and CIBERONC, Virgen del Valle Hospital, Toledo, Spain; Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
| | | | - Angela S Bowman
- The Mast Cell Disease Society, Inc. (DBA The Mastocytosis Society, Inc.), Sterling, Mass; Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, Tenn
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Horia Bumbea
- European Center of Excellence in Mastocytosis, Hematological Rare Disease Center, Department of Hematology, Emergency University Hospital Bucharest, Bucharest, Romania
| | - Claudia de Haro
- Mexican Association of Mastocytosis, AC, Mexico City, Mexico
| | - Jie Shen Fok
- Allergy and Clinical Immunology, Box Hill Hospital, Eastern Health, Box Hill, Victoria, Australia; Immunology and Allergy, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Karin Hartmann
- Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Nicole Hegmann
- Mastocytosis Self-Support Network, eV, Odenthal, Germany
| | - Olivier Hermine
- Imagine Institute Université de Paris Descartes, Sorbonne, Institut National de la Santé et de la Recherche Médicale, Centre National de Référence des Mastocytoses (CEREMAST), Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Constance H Katelaris
- Department of Medicine, Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, New South Wales, Australia; Immunology and Allergy Unit, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | | | | | - David Mayne
- The Australasian Mastocytosis Society, Port Macquarie, New South Wales, Australia
| | - David Mendoza
- Pediatric Allergy and Clinical Immunology, Instituto Nacional de Pediátria, Mexico City, Mexico
| | - Alain Moussy
- French Association for Research Initiatives on Mast Cells and Mastocytosis (AFIRMM), Paris, France
| | | | | | - Marek Niedoszytko
- Allergology Department, Medical University of Gdansk, Gdansk, Poland
| | - Hanneke Oude Elberink
- Department of Allergology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alberto Orfao
- Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain; Servicio Central de Citometria, Centro de Investigacion del Cancer (IBMCC; CSIC/USAL), Instituto Biosanitario de Salamanca (IBSAL), CIBERONC and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Deepti H Radia
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Eugenia Ribada
- Spanish Association of Mastocytosis and Related Diseases (AEDM), Madrid, Spain
| | | | - Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - Frank Siebenhaar
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | | | - Rocio Velazquez
- Mexican Association of Mastocytosis, AC, Mexico City, Mexico
| | - Yvon Wielink
- Mastocytosis Association Netherlands, Almere, The Netherlands
| | - Friedrich Wimazal
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Timo Yigit
- Self-Support Association Mastocytosis eV, Toenisvorst, Germany
| | - Celia Zubrinich
- Allergy and Clinical Immunology, Alfred Health, Melbourne, Victoria, Australia
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
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19
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Drugs and Vaccines Hypersensitivity in Children with Mastocytosis. J Clin Med 2022; 11:jcm11113153. [PMID: 35683540 PMCID: PMC9181546 DOI: 10.3390/jcm11113153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
Mastocytosis, a heterogeneous mastcell disease, include three different entities: cutaneous mastocytosis, systemic mastocytosis (SM) and mast-cell sarcoma. Tryptase levels can differentiate cutaneous mastocytosis from SM. In mastocytosis, quick onset drug hypersensitivity reactions (DHRs) that are facilitated by mastcell mediators, are investigated in adults. Due to the limited number of children with mastcell disease and increased serum tryptase levels, the role of drugs in this age group is less studied. In this review, we critically assessed relevant papers related with immediate DHRs in children with mastocytosis and discuss practical issues of the management. In childhood mastocytosis, anaphylaxis is frequently idiopathic, and elevated level of basal tryptase, and high burden of disease may increase the risk. Among drugs, antibiotics, NSAIDs and opioids can potentially induce anaphylaxis, anyway avoidance should be recommended only in case of previous reactions. Moreover, vaccinations are not contraindicated in patients with mastocytosis. The risk of severe systemic reactions after drugs intake seems to be extremely low and in general lower in children than in adults. Anyway, studies on this topic especially focusing on children, are missing to state final recommendations.
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20
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Akin C, Arock M, Valent P. Tyrosine kinase inhibitors for the treatment of indolent systemic mastocytosis: are we there yet? J Allergy Clin Immunol 2022; 149:1912-1918. [PMID: 35487307 DOI: 10.1016/j.jaci.2022.04.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
Indolent systemic mastocytosis (ISM) is the most prevalent form of systemic mastocytosis. Many patients with ISM suffer from mast cell (MC) mediator-related symptoms In a small number of patients, hematologic progression is seen in the follow up. In some patients with ISM, symptoms arising from MC-derived mediators including gastrointestinal symptoms, anaphylaxis, neuropsychiatric symptoms are kept under control with conventional mediator-targeting drugs or MC-stabilizing agents. However, in a substantial number of patients, the symptoms are refractory to such conventional therapy. For these patients, novel drugs and targeted approaches are considered. One reasonable approach may be to apply tyrosine kinase inhibitors directed against KIT and other key kinase targets expressed in neoplastic MC in ISM. Since MC in over 90% of all patients with typical ISM display the KIT D816V mutant receptor, clinically effective KIT-targeting drugs have to be active against this mutant form of KIT. The two such most effective and well-studied agents currently available are midostaurin and avapritinib. Other KIT-targeting drugs, such as imatinib or masitinib, are less effective or even non-effective against KIT D816V and are thus only recommended for use in patients with other KIT mutant forms (non codon 816 mutations) or with wild type KIT. In the present article, we review the current state in the treatment of ISM with tyrosine kinase inhibitors, with special emphasis on treatment responses and potential adverse effects. In fact, all of these agents also have unique and common adverse effects, and their use to treat ISM patients should be balanced against their toxicity and short and long term safety.
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Affiliation(s)
- Cem Akin
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Michel Arock
- Department of Hematological Biology, Pitié-Salpêtrière Charles-Foix Hospital, AP-HP Sorbonne University, Paris, France
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Austria
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21
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Pharm.D. MA, Hoermann G, Sotlar K, Hermine O, Sperr WR, Hartmann K, Brockow K, Akin C, Triggiani M, Broesby-Olsen S, Reiter A, Gotlib J, Horny HP, Orfao A, Metcalfe DD, Valent P. Clinical Impact and Proposed Application of Molecular Markers, Genetic Variants and Cytogenetic Analysis in Mast Cell Neoplasms: Status 2022. J Allergy Clin Immunol 2022; 149:1855-1865. [DOI: 10.1016/j.jaci.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/28/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
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22
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Hoermann G, Sotlar K, Jawhar M, Kristensen T, Bachelot G, Nedoszytko B, Carter MC, Horny HP, Bonadonna P, Sperr WR, Hartmann K, Brockow K, Lyons JJ, Kluin-Nelemans HC, Hermine O, Akin C, Broesby-Olsen S, Triggiani M, Butterfield JH, Schwaab J, Reiter A, Gotlib J, Metcalfe DD, George TI, Orfao A, Valent P, Arock M. Standards of Genetic Testing in the Diagnosis and Prognostication of Systemic Mastocytosis in 2022: Recommendations of the EU-US Cooperative Group. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1953-1963. [PMID: 35283331 DOI: 10.1016/j.jaip.2022.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
Mastocytosis comprises rare heterogeneous diseases characterized by an increased accumulation of abnormal mast cells in various organs/tissues. The pathogenesis of mastocytosis is strongly linked to the presence of KIT-activating mutations. In systemic mastocytosis (SM), the most frequent mutation encountered is KIT p.D816V, whose presence constitutes one of the minor diagnostic criteria. Different techniques are used to search and quantify the KIT p.D816V mutant; however, allele-specific quantitative PCR and droplet digital PCR are today the most sensitive. The analysis of the KIT p.D816V allele burden has undeniable interest for diagnostic, prognostic, and therapeutic monitoring. The analysis of non-mast cell hematological compartments in SM is similarly important because KIT p.D816V multilineage involvement is associated with a worse prognosis. In addition, in advanced forms of SM, mutations in genes other than KIT are frequently identified and affect negatively disease outcome and response to therapy. Thus, combined quantitative and sensitive analysis of KIT mutations and next-generation sequencing of other recurrently involved myeloid genes make it possible to better characterize the extent of the affected cellular compartments and additional molecular aberrations, providing a more detailed overview of the complex mutational landscape of SM, in relation with the clinical heterogeneity of the disease. In this article, we report the latest recommendations of the EU-US Cooperative Group presented in September 2020 in Vienna during an international working conference, on the techniques we consider standard to detect and quantify the KIT p.D816V mutant in SM and additional myeloid mutations found in SM subtypes.
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Affiliation(s)
- Gregor Hoermann
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria; MLL Munich Leukemia Laboratory, Munich, Germany.
| | - Karl Sotlar
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mohamad Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - Thomas Kristensen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Guillaume Bachelot
- Department of Hematological Biology, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University (UPMC), Paris, France
| | - Boguslaw Nedoszytko
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Melody C Carter
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Wolfgang R Sperr
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Karin Hartmann
- Division of Allergy, Department of Dermatology, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Jonathan J Lyons
- Translational Allergic Immunopathology Unit, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Hanneke C Kluin-Nelemans
- Department of Haematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Olivier Hermine
- Imagine Institute, Université Paris Descartes, Sorbonne, Paris Cité, Centre national de référence des mastocytoses, Paris, France
| | - Cem Akin
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | | | - Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - Jason Gotlib
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, Calif
| | - Dean D Metcalfe
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Tracy I George
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Alberto Orfao
- Servicio Central de Citometria, Centro de Investigacion del Cancer (IBMCC; CSIC/USAL), Instituto Biosanitario de Salamanca, Salamanca, Spain; Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Peter Valent
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Michel Arock
- Department of Hematological Biology, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University (UPMC), Paris, France.
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23
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Abstract
Mastocytoses are characterized by clonal proliferation of mast cells in various tissues. In childhood, cutaneous mastocytosis (CM) occurs almost exclusively. It is confined to the skin, and has a good prognosis. The most common form is the maculopapular cutaneous mastocytosis (MPCM), formerly called urticaria pigmentosa. A distinction is made between a monomorphic variant of MPCM with multiple small, roundish maculopapular skin lesions and the - more common - polymorphic variant with larger lesions of variable size. One quarter of CM diagnosed in childhood are mastocytomas, which often occur solitary or at multiple sites. The diffuse variant of CM (DCM), which affects 5% of children with CM, should be distinguished from these forms. Systemic mastocytoses (SM) with mast cell infiltrates in the bone marrow or other extracutaneous tissues, such as the gastrointestinal tract, occur predominantly in adults. The diagnosis of CM is usually made clinically: Manifestation in infancy, typical morphology and distribution, pathognomonic Darier sign. Basal serum tryptase is determined if DCM or systemic mastocytosis are to be diagnosed. Children with mastocytosis should be managed in a specialized outpatient clinic. For affected families, detailed information about the clinical picture including prognosis assessment is essential. Mast cell mediated symptoms are controlled by oral non-sedating antihistamines if needed.
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24
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Itoh N, Yasutomi M, Oyama N, Hasegawa M, Ohshima Y. Progress of telangiectasia macularis eruptiva perstans exacerbated egg allergy. Pediatr Int 2022; 64:e15235. [PMID: 35859252 DOI: 10.1111/ped.15235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Naohiro Itoh
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Motoko Yasutomi
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Noritaka Oyama
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Minoru Hasegawa
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yusei Ohshima
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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25
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Calvani M. Update on idiopathic anaphylaxis. Pediatr Allergy Immunol 2022; 33 Suppl 27:52-53. [PMID: 35080312 DOI: 10.1111/pai.13629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/28/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022]
Abstract
Idiopathic anaphylaxis (AI) refers to anaphylaxis without a recognizable cause after a comprehensive allergic workup. The diagnostic approach usually includes an accurate clinical history aimed at excluding both the most and the less frequent causes of anaphylaxis and all pathologies that may resemble anaphylaxis. AI is more common in adults than in children. The epidemiology of AI has been reduced in recent years, probably to increase knowledge and discover new clinical entities, such as the α-gal anaphylaxis. Anaphylaxis results from the massive activation of the mast cells (MCs). Thus, it is also necessary to exclude MC disorders, such as mastocytosis and mast cell activation syndrome, and α-tryptasemia, which may manifest with IA symptoms.
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Affiliation(s)
- Mauro Calvani
- Pediatric Complex Operative Unit, "S. Camillo-Forlanini" Hospital, Rome, Italy
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26
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Abstract
Mastocytosis is a rare clonal disorder characterized by excessive proliferation and accumulation of mast cells (MC) in various organs and tissues. Cutaneous mastocytosis (CM), the most common form in children, is defined when MC infiltration is limited to the skin. In adults, the most common form is systemic mastocytosis (SM), characterized by MC proliferation and accumulation in organs, such as bone marrow, lymph nodes, liver, and spleen.1 Genetic aberrations, mainly the KIT D816V mutation, play a crucial role in the pathogenesis of mastocytosis, enhancing MC survival and subsequent accumulation in organs and tissues.2,3 CM includes three forms: solitary mastocytoma, maculopapular cutaneous mastocytosis (MPCM), and diffuse cutaneous mastocytosis (DCM). In most children with CM, skin lesions regress spontaneously around puberty; unfortunately, it is not always a self-limiting disease.4 Even if SM occurs occasionally, all children with mastocytosis require planned follow-up over time. Children with mastocytosis often suffer from MC mediator-related symptoms, the most common of which is itching, often triggered by rubbing the lesions. Management of pediatric mastocytosis is mainly based on strict avoidance of triggers. Treatment with H1 and H2 histamine receptor blockers on demand and the availability of epinephrine auto-injectors for the patients to use in case of severe anaphylactic reactions are recommended.
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27
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Abstract
Historically, understanding of the human mast cell (MC) compartment has lagged behind the appreciation of other cell lineages. MCs exist in vascularised tissues but do not under normal circumstances circulate in blood, and there has been no pharmacological agent identified that totally and selectively inhibits human MC function. There are no substantiated accounts of an apparently healthy individual who is severely lacking in MCs. Thus, some of the approaches employed to understand the function of a specific immune cell are not available to the MC biologist. The disease categories that have provided the greatest insight into MC biology have been monoclonal and IgE-mediated MC disorders. This has led to the categorisation of MC diseases as intrinsic or extrinsic to the MC compartment and to the recognition of the role of mediators in MC activation disorders. Mastocytosis as a clonal disorder not only impacts the MC compartment through changes intrinsic to the MC, but also by the effects of episodes of significant release of MC mediators. The availability of newer therapeutic approaches developed to treat monoclonal MC disorders offer insights into how to more selectively approach management of MC centric diseases.
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Affiliation(s)
- Melody C Carter
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Dean D Metcalfe
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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