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Case Report: perioperative immediate hypersensitivity involves not only allergy but also mastocytosis.
[cutaneous mastocytosis]
We
report
a
case
of
drug-induced
immediate
hypersensitivity
occurring
after
atracurium
injection
in
a
patient
with
cutaneous
mastocytosis
.
A
69
-
yr
-old
woman
was
scheduled
for
hysterectomy
.
She
was
premedicated
with
hydroxyzine
,
and
anesthesia
was
induced
with
sufentanil
,
propofol
,
and
atracurium
.
Within
two
to
three
minutes
following
the
injection
of
atracurium
,
the
patient
experienced
an
episode
of
generalized
erythema
and
arterial
hypotension
associated
with
tachycardia
.
No
bronchospasm
was
observed
.
Her
cardiovascular
signs
resolved
spontaneously
within
five
minutes
,
while
her
cutaneous
signs
disappeared
within
30
min
.
Anesthesia
and
surgery
remained
uneventful
.
The
patient
's
serum
tryptase
levels
were
measured
at
different
time
points
following
the
clinical
reaction
.
An
in
vitro
flow
cytometry-based
basophil
activation
test
was
performed
with
atracurium
,
and
in
vivo
skin
tests
to
latex
and
all
drugs
which
were
administered
just
before
the
clinical
reaction
were
also
done
.
The
serum
tryptase
showed
increased
concentrations
that
remained
elevated
for
24
hr
,
48
hr
,
and
even
four
weeks
after
the
clinical
reaction
.
Atracurium
did
not
induce
either
CD
63
or
CD
2
03
c
upregulation
,
and
the
skin
tests
were
negative
in
response
to
the
medications
received
(
propofol
,
sufentanil
,
and
atracurium
)
as
well
as
to
latex
.
Allergic
hypersensitivity
to
atracurium
was
ruled
out
.
Increased
tryptase
concentrations
following
the
clinical
reaction
,
persistent
increased
levels
of
basal
serum
tryptase
,
and
negative
skin
tests
suggested
the
onset
of
mast
cell
degranulation
in
a
patient
with
mastocytosis
.
Immediate
reaction
occurring
in
patients
with
mastocytosis
should
be
investigated
in
order
to
identify
the
mechanism
of
the
reaction
,
either
histamine
release
due
to
the
disease
itself
or
due
to
a
concurrent
drug
/
agent
-induced
IgE-mediated
mechanism
.
Diseases
Validation
Diseases presenting
"skin tests"
symptom
acute rheumatic fever
allergic bronchopulmonary aspergillosis
cutaneous mastocytosis
kabuki syndrome
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