Assessing vaccination reactions in pediatric patients with maculopapular cutaneous mastocytosis

Johansen, Maija; Lawley, Leslie P.

doi:10.1111/pde.14492

Cited by 12 publications

(10 citation statements)

References 5 publications

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“…A recent retrospective study of 35 patients evaluated vaccination reactions in pediatric patients with MPCM (Table 2) (23). The study's conclusions are similar to previous ones and highlight that vaccination reactions in mastocytosis tend to be mild, so scheduled vaccinations should be continued (23).…”

Section: ) (22)supporting

confidence: 66%

Case Report and Review of the Literature: Bullous Skin Eruption After the Booster-Dose of Influenza Vaccine in a Pediatric Patient With Polymorphic Maculopapular Cutaneous Mastocytosis

et al. 2021

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Vaccination is a well-known trigger for mast cell degranulation in subjects affected by mastocytosis. Nevertheless, there is no exact standardized protocol to prevent a possible reaction after a vaccine injection, especially for patients who have already presented a previous vaccine-related adverse event, considering that these patients frequently tolerate future vaccine doses. For this reason, we aim to share our experience at Meyer Children’s University Hospital in Florence to raise awareness on the potential risk for future vaccinations and to discuss the valuable therapeutic strategies intended to prevent them, taking into account what is proposed by experts in literature. We describe the case of an 18-month-old female affected by a polymorphic variant of maculopapular cutaneous mastocytosis that presented an extensive bullous cutaneous reaction 24 hours after the second dose (booster dose) of inactivated-tetravalent influenza vaccine, treated with a single dose of oral corticosteroid therapy with betamethasone (0.1 mg/kg) and an oral antihistamine therapy with oxatomide (1 mg/kg/daily) for a week, until resolution. To the best of our knowledge, in the literature, no documented case of reaction to influenza vaccine in maculopapular cutaneous mastocytosis is described. Subsequently, the patient started a background therapy with ketotifen daily (0.05 mg/kg twice daily), a non-competitive H1-antihistamine, and a mast cell stabilizer (dual activity). A non-standardized pharmacological premedication protocol with an H1-receptor antagonist (oxatomide, 0.5 mg/kg) administered 12 hours before the immunizations, and a single dose of betamethasone (0.05 mg/kg) together with another dose of oxatomide (0.5 mg/kg) administered 2 hours before the injections was followed to make it possible for the patient to continue with the scheduled vaccinations. Indeed, no reactions were subsequently reported. Thus, in our experience, a background therapy with ketotifen associated with a premedication protocol made by two doses of oxatomide and a single dose of betamethasone was helpful to make possible the execution of the other vaccines. We suggest how in these children, it could be considered the idea of taking precaution when vaccination is planned, regardless of the kind of vaccine and if a dose of the same vaccine was previously received. However, international consensus needs to be reached to manage vaccinations in children with mastocytosis and previous adverse reactions to vaccines.

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Section: ) (22)supporting

confidence: 66%

Case Report and Review of the Literature: Bullous Skin Eruption After the Booster-Dose of Influenza Vaccine in a Pediatric Patient With Polymorphic Maculopapular Cutaneous Mastocytosis

et al. 2021

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“…The evidence is lacking to avoid NSAIDs and for pre-test evaluation in children with mastocytosis. Last but not at least, mastocytosis does not contraindicate vaccination [ 80 ], also taking into account that children with mastocytosis have a slightly increased risk of reaction in comparison with the general population [ 70 ]. Reactions are frequently mild with exceedingly rare bullous eruptions or more severe cases of MC degranulation.…”

Section: Discussionmentioning

confidence: 99%

Drugs and Vaccines Hypersensitivity in Children with Mastocytosis

Mori

Crisafulli

Bianchi

et al. 2022

JCM

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Mastocytosis, a heterogeneous mastcell disease, include three different entities: cutaneous mastocytosis, systemic mastocytosis (SM) and mast-cell sarcoma. Tryptase levels can differentiate cutaneous mastocytosis from SM. In mastocytosis, quick onset drug hypersensitivity reactions (DHRs) that are facilitated by mastcell mediators, are investigated in adults. Due to the limited number of children with mastcell disease and increased serum tryptase levels, the role of drugs in this age group is less studied. In this review, we critically assessed relevant papers related with immediate DHRs in children with mastocytosis and discuss practical issues of the management. In childhood mastocytosis, anaphylaxis is frequently idiopathic, and elevated level of basal tryptase, and high burden of disease may increase the risk. Among drugs, antibiotics, NSAIDs and opioids can potentially induce anaphylaxis, anyway avoidance should be recommended only in case of previous reactions. Moreover, vaccinations are not contraindicated in patients with mastocytosis. The risk of severe systemic reactions after drugs intake seems to be extremely low and in general lower in children than in adults. Anyway, studies on this topic especially focusing on children, are missing to state final recommendations.

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“…They were shown to 10 independent observers (eight dermatologists, one allergist and one haematologist) from Europe and North America with a vast experience in the management of paediatric mastocytosis. The expert observers were selected by their membership in large research groups in mastocytosis and their authorship of scientific studies involving large number of cases of childhood mastocytosis 2,9–13 . The observers were sent a presentation containing at least two pictures of each case, and they blindly filled a table to ascribe each case in the polymorphic or monomorphic variant.…”

Section: Methodsmentioning

confidence: 99%

Interobserver variability in the classification of childhood maculopapular cutaneous mastocytosis

Torrelo

Vergara‐de‐la‐Campa

Defez

et al. 2021

Acad Dermatol Venereol

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Background Maculopapular cutaneous mastocytosis (MPCM) in children is classified in two variants: (i) monomorphic variant, presenting with the small macules or papules typically seen in adult patients; and (ii) polymorphic variant with larger lesions of variable size and shape, typically seen in children. The definition of polymorphic and monomorphic variants is mostly intuitive, and a validation of this classification has not been done. Objective To study interobserver variability in the classification of MPCM in two groups of observers: mastocytosis experts and general dermatologists. Materials and methods Nineteen cases of childhood MPCM were shown blindly, for classification as monomorphic or polymorphic type, to 10 independent observers (eight dermatologists, one allergist and one haematologist) from Europe and North America with a vast experience in the management of paediatric mastocytosis. Also, the same cases were shown on a screen to 129 general dermatologists attending a meeting; their votes were registered by remote controls. The interobserver variability kappa coefficient (with 95% confidence interval) was calculated to measure the reliability of the correlation. Results The value of kappa interobserver variability coefficient for the group of 10 experts (95% confidence interval) was 0.39 (0.18–0.63), which is considered as ‘fair’. The value of kappa interobserver variability coefficient for the group of 129 general dermatologists (95% confidence interval) was 0.17 (0.06–0.39), which is considered as ‘slight’. A complete agreement of all 10 experts was achieved in only four of 19 cases (21.1%) The most voted choice was concordant between the two groups in only 11 of the 19 cases. Conclusions We failed to validate the classification system of childhood MPCM in monomorphic and polymorphic types. While the rate of agreement was low for mastocytosis experts, it was nearly the agreement expected by chance in general dermatologists.

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Assessing vaccination reactions in pediatric patients with maculopapular cutaneous mastocytosis

Cited by 12 publications

References 5 publications

Case Report and Review of the Literature: Bullous Skin Eruption After the Booster-Dose of Influenza Vaccine in a Pediatric Patient With Polymorphic Maculopapular Cutaneous Mastocytosis

Case Report and Review of the Literature: Bullous Skin Eruption After the Booster-Dose of Influenza Vaccine in a Pediatric Patient With Polymorphic Maculopapular Cutaneous Mastocytosis

Drugs and Vaccines Hypersensitivity in Children with Mastocytosis

Interobserver variability in the classification of childhood maculopapular cutaneous mastocytosis

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