Histamine Liberation by Codeine and Polymyxin B in Urticaria Pigmentosa

Longitudinal Study of Pediatric Urticaria Pigmentosa

“…There were no reported complications from ibuprofen. Several anesthetic agents and cough medicines containing opioids have been associated with mast cell degranulation, with the potential for cardiovascular shock, bronchospasm, and death in patients with cutaneous mastocytosis . Consistent with a prior report of dextromethorphan cough suppressant causing cutaneous flare, two (6%) subjects had erythema and pruritus with non‐opioid‐containing cough medications .…”

Anesthesia in children with mastocytosis – a case based review

“…The authors gave subcutaneous injections of codeine to five patients of whom three were children. In three of five subjects systemic symptoms were reported in response to codeine, in three of five challenges systemic symptoms were reported to polymyxin B. Subcutaneous codeine induced flushing and an increase in urinary histamine excretion (31).…”

“…Induction or promotion of mediator release has been ascribed to trigger factors, conventional advice suggests that these triggers should be avoided e.g. emotional or environmental stress, aspirin, morphine and its derivatives, tubocurare type muscle relaxants, alcohol, antibiotics and radiocontrast media (31). It is acknowledged that there is little data on which to base these recommendations (32) with some experience suggesting that drugs commonly believed to be contra-indicated are a problem in <10% of patients (3).…”

Paediatric mastocytosis

“…50 Patients with mastocytosis may also be more sensitive to venoms of stinging insects. There are a number of activators of mast cell secretion, which work through immunological and nonimmunological mechanisms, which are summarised in table 4.…”