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

BACKGROUND Anaphylaxis is a severe, systemic hypersensitivity reaction that poses a potential threat to life. The occurrence of mastocytosis increases the likelihood of severe anaphylactic reactions. Appropriate management is crucial for improving clinical outcomes. CASE REPORT The case describes severe anaphylactic shock in a 31-year-old female patient with suspected mastocytosis. The shock occurred following a sting by a hymenopteran insect. The patient required mechanical ventilation and circulatory support for cardio-respiratory failure. Because of insufficient response to intramuscular injections of epinephrine, continuous intravascular infusion was needed. Intensive fluid therapy with balanced crystalloids was administered. As part of supportive treatment, antihistamines (rupatadine via a nasogastric tube) and intravenous glucocorticosteroids were given. Acid-base disturbances were also corrected. The patient was discharged from the intensive care unit on the third day of hospitalization in good general condition. CONCLUSIONS The core management of anaphylaxis in a patient with suspected or diagnosed mastocytosis is similar to the general recommendations for anaphylaxis treatment. However, it should be noted that patients with mastocytosis can have significantly higher requirements for adrenaline. Continuous intravenous infusion of adrenaline during the first 1 to 2 days following the onset of anaphylaxis may be warranted. Due to the rapid course of anaphylaxis and excessive immune response, more severe disturbances in organ perfusion can occur, resulting in metabolic acidosis. In such patients, intravenous infusion of sodium bicarbonate can be necessary. Therefore, patients with mastocytosis who experience anaphylaxis may be less responsive to epinephrine and should be admitted to the intensive care unit early.