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Practical file, Alim’Inter – Medic’Inter Symptomatic taking charge of systemic mastocitis
Martine Morisset, Patricia Sergeant, Simone Widmer, Gisèle Kanny Médecine Interne, Immunologie Clinique et Allergologie. Hôpital Central. 54035 NANCY Cedex Symptomatic treatment
- H1 antihistamine
- Sodium cromoglycate per os : to prevent degranulation of digestive mast cells
- Biphosphonates : to prevent osteoporosis
- PUVAtherapy : to sedate pruriginous cutaneous lesions
- Emergency kit and prescription of a protocole of emergency care
- Epinephrine IM in case of cardio-respiratory distress. Avaible as an auto-injectable,
pen ANAPEN in all French hospitals Pharmacies.
- Beta 2 adrenergic agonist (Salbutamol or Terbutaline) in spray with inhaling room
- Corticosteroïds per os
(The basic treatment has to be adapted specifically to every case : corticotherapy, Interferon alpha, imatinib tyrosine
kynase inhibitor and it is not at all the subject of the present practical paper)
Hygieno-dietetic measures
- Limit stimulating factors : frictions, thermic shocks (bath), and even physical exercices or - Avoid being stung by insects, especially hymenopters (wasp, bee) ; avoid the contact with jellyfish, ray, processionary caterpillars, snake bites.
- Avoid any kinds of food favouring histamine liberation.
Service de Médecine Interne, Immunologie Clinique et Allergologie - Hôpital Central - 29, Av. de Lattre de Tassigny - 54035 NANCY Cedex Type of food
Food to be avoided
Sauerkraut, strawberries, tomatoes (tomato sauce++), spinach Cooked pork meats (++), hanged game, offal Seefoods, smoked fish, fish with red flesh (tunny fish, mackerel, salmon), anchovy, nuoc mansauce Cheese with cooked paste : gruyere cheese,beaufort, gouda, great quantity of white egg Chocolate, very spiced food, excessive use ofcaffeine and tea Medecines not to be advised
Aspirin, non-steroidal anti-inflammatory drugs (NSAIDS)
Codeine and morphinics
Bromhydrate of dextrometorphane (cough sedative++)
Amphetamines
HL antibiotics : Vancomycin ++, Polymyxin B +/- colistine, Quinolones
Anti-hypertension : betablockers ++, Angiotensin converting enzyme inhibitors (ACEI), reserpin,
hydralazin
Miscellaneous : Protamin, amphotericin BIV, scopolamine (mainly palliative care), pilocarpine(collyrium), injectable THIAMINE, QUININE ? NEOMYCIN ? In case of achievement of examinations with use of iodized contrast products (ICP) :
Use a normo-osmolary ICP with a premedication by hydroxyzine the evening before and one
hour before the test and corticotherapy _ mg/kg per day to be begun three days before the test.
In case of local anaesthesia :
Preferentyl, use an anaesthetic among the type lidocaine without conservative and vaso-
constrictor.
In case of general anaesthesia and surgical intervention
- Reassure the patient, and, if possible, propose a “planned” intervention
- Premedication by H1 antihistamine (hydroxyzine) the evening before and one hour before the
intervention.
Corticotherapy should be begun 3 days before, if possible.
Service de Médecine Interne, Immunologie Clinique et Allergologie - Hôpital Central - 29, Av. de Lattre de Tassigny - 54035 NANCY Cedex - The temperatureof the operating room should not be too low (need of specialized advice in
case of ECC…). Concerns also the material used (operating table++) or the filling up solutions.
- Avoid filling up solutions containing Dextrans.
- Limit factors that may irrit skin (adhesives)
- Gentle intubation (in order to avoid traumatisms of nasal fossae and of the laryngeal tractus)
- Avoid traumatic positions by protecting leaning points
- Invasive monitoring to be avoided except in case of surgical requirement.
- Post-operation analgesia : avoid morphine (histamine liberation)
- If a curare is required : slow injection (one minute) rather than a bolus (avoid use of
Atracurium and Mivacurium, both being responsible of histamine liberation) - If narcotic gas needed, preferably use Isoflurane among all kinds of halogen gas existing- Syringe of epinephrine (1 mg in 9 ml NaCl 9°/°°) and an aerosol with a broncho-distending NB : In the very exceptional case in which mastocitis should be associated quite independently to
a true allergy (relative to food, respiratory tractus or drug), evictions linked to this specific
affection should be included and added to the treatment.
Service de Médecine Interne, Immunologie Clinique et Allergologie - Hôpital Central - 29, Av. de Lattre de Tassigny - 54035 NANCY Cedex

Source: http://www.cicbaa.org/pages_us/fiches/mastocytes.pdf