Drug hypersensitivity in patients with presumed
histamine intolerance and
mast cell activation disease Abstract. There is no evidence to suggest that sensitization against drugs occurs more frequently among patients with presumed
histamine intolerance compared to patients with normal tolerance to
histamine. However, preclinical data suggest interactions between some drugs and
histamine catabolism. Nevertheless, the clinical relevance of these findings remains unclear as
histamine in humans can be catabolized by different pathways. There are no drugs for which induction or worsening of
histamine intolerance has been established clinically. In patients with
mastocytosis an increased rate of sensitization and specific
allergies to drugs is unlikely. However, pathophysiologic understanding suggests that
mast cell activation disease might enhance drug reactions, which are induced by mast cell degranulation. Additionally a possible lower threshold for unspecific mast cell degranulation in patients with
mastocytosis could lead to pseudoallergic drug reactions. However an increase in the number of drug substances triggering such reactions is not expected. Nevertheless, there are lists of drug substances which are assumed to cause anaphylactic /
anaphylactoid reactions especially in patients with
mastocytosis. Conversely, these lists are rarely based on clinical evidence. A recently published prospective trial did not find any relevant increase of acetyl
salicylic acid hypersensitivity in patients with
mastocytosis. Patients with
mastocytosis and a history of
drug hypersensitivity should be thoroughly assessed by an allergological workup and advised to avoid triggering and / or cross reactive drug substances. We recommend that these patients avoid drugs which may interfere with the treatment of
anaphylaxis like beta blockers, certain
antidepressants or
Catechol-O-methyltransferase inhibitors because of the increased risk for enhanced
hypersensitivity reactions.