Management Strategy for Anaphylaxis in a Patient With Suspected or Confirmed Mastocytosis: A Case Report

Area of Science:

• Allergy and Immunology
• Emergency Medicine

Background:

• Anaphylaxis is a life-threatening systemic hypersensitivity reaction.
• Mastocytosis increases the risk and severity of anaphylactic events.
• Effective management is vital for patient outcomes.

Purpose of the Study:

• To report a case of severe anaphylactic shock in a patient with suspected mastocytosis.
• To highlight the unique management challenges and considerations for anaphylaxis in mastocytosis.

Main Methods:

• Case report of a 31-year-old female with suspected mastocytosis experiencing anaphylaxis after an insect sting.
• Management included mechanical ventilation, circulatory support, continuous intravascular epinephrine infusion, fluid therapy, antihistamines, glucocorticosteroids, and acid-base correction.

Main Results:

• The patient required intensive support, including continuous epinephrine infusion due to poor response to intramuscular injections.
• Supportive care and interventions led to recovery, with discharge on day three.
• Mastocytosis patients may exhibit significantly higher adrenaline requirements.

Conclusions:

• Anaphylaxis management in mastocytosis aligns with general guidelines but necessitates consideration of increased adrenaline needs.
• Continuous intravenous epinephrine infusion may be required for 1-2 days.
• Early intensive care unit admission is recommended due to potential for severe organ dysfunction and metabolic acidosis.