Mast cell conditions and drug allergy

Mast cell disorders, specifically systemic mastocytosis, are associated with an increased risk of drug hypersensitivity reactions. Among medications, nonsteroidal anti-inflammatory drugs are the most frequent triggers, followed by antibiotics and perioperative drugs. Although drug-induced reactions, particularly anaphylaxis, are a major concern, recent data suggest that the overall prevalence of severe reactions is relatively low. Nevertheless, drug avoidance behaviors remain frequent, often leading to unnecessary therapeutic restrictions. This review discusses the available evidence on drug hypersensitivity reactions in mastocytosis, focusing on the most frequent drug triggers and their management. Individualized assessment should be prioritized, relying on a detailed clinical history to guide decisions. In patients without a history of hypersensitivity, new treatments can often be introduced safely, whereas those with previous reactions may benefit from careful risk stratification, skin testing, or supervised drug provocation testing. A history-driven, evidence-based approach allows most patients with mast cell disorders to be treated effectively without unnecessary drug avoidance.