Aspirin idiosyncrasy in systemic mast cell disease: A new look at mediator release during aspirin desensitization

J. H. Butterfield, P. C. Kao, G. G. Klee, M. W. Yocum

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Objective: To report the clinical responses and mediator-release profiles of an aspirin-sensitive man with systemic mast cell disease during aspirin desensitization. Material and Methods: We quantified the release of six mediators during aspirin desensitization. Results: Although aspirin was administered cautiously with an initial dose of 20 mg, successful aspirin desensitization necessitated complete monitoring and resuscitation capabilities of a medical intensive-care unit for 4.5 days because of frequent, severe anaphylactoid responses. To our knowledge, this is the first report of a pronounced increase in plasma levels of the vasodilator peptide calcitonin gene-related peptide during episodes of aspirin-induced hypotension. Increases in plasma levels of calcitonin and serum levels of tryptase paralleled those of calcitonin gene-related peptide, but plasma levels of calcitonin remained increased for up to 18 hours. Urinary excretion of histamine and 1-methyl-4-imidazoleacetic acid also showed precipitous, although delayed, increases. Excretion of the prostaglandin D2 metabolite 11β-prostaglandin F(2α) followed a bimodal pattern during aspirin desensitization; after severe hypotensive responses, the maximal value was more than 490,000 pg/mL, but the level decreased to less than 100 pg/mL after therapeutic serum levels of salicylate were attained. Conclusion: These data suggest that the hypotensive responses to aspirin in some patients with systemic mast cell disease may result from the combined effects of several mediators.

Original languageEnglish (US)
Pages (from-to)481-487
Number of pages7
JournalMayo Clinic Proceedings
Volume70
Issue number5
StatePublished - 1995

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Systemic Mastocytosis
Aspirin
Calcitonin Gene-Related Peptide
Calcitonin
Controlled Hypotension
Prostaglandin D2
Tryptases
Salicylates
Prostaglandins F
Serum
Vasodilator Agents
Resuscitation
Histamine
Intensive Care Units
Peptides

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Aspirin idiosyncrasy in systemic mast cell disease : A new look at mediator release during aspirin desensitization. / Butterfield, J. H.; Kao, P. C.; Klee, G. G.; Yocum, M. W.

In: Mayo Clinic Proceedings, Vol. 70, No. 5, 1995, p. 481-487.

Research output: Contribution to journalArticle

Butterfield, J. H. ; Kao, P. C. ; Klee, G. G. ; Yocum, M. W. / Aspirin idiosyncrasy in systemic mast cell disease : A new look at mediator release during aspirin desensitization. In: Mayo Clinic Proceedings. 1995 ; Vol. 70, No. 5. pp. 481-487.
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