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Mastocytosis

Mastocytosis is a group of rare disorders of both children and adults caused by the presence of too many mast cells (mastocytes) in a person's body. more...

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Pathophysiology

Mast cells are located in connective tissue, including the skin, the linings of the stomach and intestine, and other sites. They may play an important role in helping defend these tissues from disease. By releasing chemical "alarms" such as histamine, mast cells attract other key players of the immune defense system to areas of the body where they are needed.

Mast cells seem to have other roles as well. Because they gather together around wounds, mast cells may play a part in wound healing. For example, the typical itching you feel around a healing scab may be caused by histamine released by mast cells. Researchers also think mast cells may have a role in the growth of blood vessels (angiogenesis). No one with too few or no mast cells has been found, which indicates to some scientists that we may not be able to survive with too few mast cells.

Mast cells express a cell surface receptor termed c-kit (CD117), which is the receptor for scf (stem cell factor). In laboratory studies, scf appears to be important for the proliferation of mast cells, and inhibiting the tyrosine kinase receptor with imatinib (see below) may reduce the symptoms of mastocytosis.

History

Scientists first described urticaria pigmentosa in 1869. Systemic mastocytosis was first reported by scientists in 1936.

Symptoms

Chemicals released by mast cells cause changes in the immune system leading to typical allergy symptoms such as:

  • itching
  • abdominal cramping
  • and even anaphylaxis (shock from allergic or immune causes)

When too many mast cells exist in a person's body, the additional chemicals can cause:

  • Skin lesions
  • Abdominal discomfort
  • Diarrhea
  • Stomach ulcers
  • Episodes of very low blood pressure (including shock) and faintness
  • bone or muscle pain
  • Nausea and vomiting

Diagnosis

Doctors can diagnose urticaria pigmentosa (cutaneous mastocytosis, see below) by seeing the characteristic lesions which are dark-brown and fixed. A small skin sample (biopsy) may help confirm the diagnosis.

By taking a biopsy from a different organ, such as the bone marrow, the doctor can diagnose systemic mastocytosis. Using special techniques on a bone marrow sample, the doctor looks for an increase in mast cells. Another sign of this disorder is high levels of certain mast-cell chemicals and proteins in a person's blood and sometimes in the urine.

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Mastocytosis: What It Is and How It's Diagnosed and Treated
From American Family Physician, 6/1/99

What is mastocytosis?

Mastocytosis (say "mas-toe-sigh-toe-sis") is a rare disease of the skin (the most common form), or of other parts of the body (very rare), like the stomach, the intestines and the bone marrow. It's caused by having too many mast cells. Mast cells are a kind of blood cell.

Mastocytosis can occur at any age. It's more serious in adults. It's usually mild in children, and they often outgrow it.

What are mast cells?

Mast cells are made by your bone marrow. They're part of your immune system. They help you fight off infections. There are more of them in the skin, the lungs and the intestines. Mast cells make a chemical called histamine. Histamine can cause swelling, itching and redness when your body reacts to something like an insect bite or a bee sting.

What causes mastocytosis?

We don't know what causes mastocytosis. We do know some things that trigger the release of histamine and cause symptoms. Symptoms may be triggered by cold or heat, certain medicines, emotional stress and insect bites. The triggers aren't the same in every person.

What are the symptoms of mastocytosis?

The symptoms are different, depending on where the extra mast cells are. You might have a red and itchy rash if there are too many mast cells in your skin. You could get hives or have a rash that looks like freckles. If you rub the rash, it can get red and swollen. Sometimes the mast cells collect at one spot in your skin and cause one large lump.

You might have diarrhea and stomach pain if the mast cells are in your stomach and intestines. (This is rare).

In a few patients, the extra mast cells cause a serious reaction, like a bad allergy reaction. The blood pressure may suddenly drop to a low level and cause fainting. The person may have trouble breathing. This reaction can cause death if treatment isn't started right away.

(This kind of severe reaction is very rare.)

How does my doctor know I have mastocytosis?

The symptoms of mastocytosis can be like the symptoms of many other health problems. Your doctor may do a skin biopsy to find out what you have. Your doctor removes a small piece of skin and puts it under a microscope to look for extra mast cells. When an adult gets mastocytosis, a bone marrow biopsy may be needed to look for other blood diseases that might come along with the mastocytosis.

If you don't have a rash but you have other symptoms, like diarrhea, your doctor may do a blood test or a urine test.

How is mastocytosis treated?

Antihistamines, which are often used to treat allergies, are helpful. If a rash bothers you, your doctor may suggest that you be treated with ultraviolet light. If you have diarrhea, an oral version of a medicine called cromolyn (brand name: Gastrocrom) may help.

Treatment can stop your mast cells from releasing histamine. It can also keep the histamine from causing problems. You need to get treatment if your symptoms are severe.

Because mastocytosis can cause a severe allergy reaction, keep an emergency kit with you at all times so you can give yourself medicine to stop a bad reaction.

The best treatment for mastocytosis may be to stay away from the things that trigger your symptoms. It may help if you and your doctor list all the things that cause your symptoms. Did your symptoms start after you were exposed to heat or cold? Emotional stress? A medicine? An insect bite? Share what you learn with your doctor.

COPYRIGHT 1999 American Academy of Family Physicians
COPYRIGHT 2000 Gale Group

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