Drug Allergy Testing in a Pediatric Patient with Diffuse Cutaneous Mastocytosis

Mastocytosis represents a group of diseases characterized by excessive accumulation of mast cells in one or more tissues. It can affect only the skin or have systemic involvement. It has a low prevalence and the prognosis in children is benign. Patients with pediatric mastocytosis often require sedation or anesthesia for diagnostic and therapeutic procedures. Here, we report our experience with anesthesia in a pediatric patient with diffuse cutaneous mastocytosis undergoing surgical intervention for circumcision. The aim was to determine the risk of anesthetic drugs to be used for general anesthesia in a patient with diffuse cutaneous mastocytosis. A 5-year-old male patient who was consulted with anesthesia for circumcision operation and diagnosed with diffuse cutaneous mastocytosis by skin biopsy was not operated because of the risk of drug allergy and referred to the pediatric allergy and immunology department. Routine hemogram and biochemistry laboratory results were within normal limits. Occasional elevation of serum tryptase level was observed. Skin prick test with lidocaine did not show any significant change compared to the negative control due to dermatographism. However, intradermal tests with lidocaine 1:1 and 1:10 dilutions were negative. For drug allergy provocation test, increasing doses of lidocaine were administered subcutaneously and no reaction developed. Intradermal tests with midazolam and bupivacaine were also negative. There was no early or late reaction to any of these. In conclusion, it has been presented in the literature which drugs can be used without any problem according to intradermal test results as in our case. However, all precautions should be taken against the possibility of anaphylaxis in these patients. Re-consultation 24 hours before surgery regarding the use of prophylactic drugs is appropriate