疫苗接种是受肥大细胞增多症影响的受试者中肥大细胞脱颗粒的众所周知的触发因素。然而,没有确切的标准化方案来防止疫苗注射后可能的反应,特别是对于已经出现过疫苗相关不良事件的患者,考虑到这些患者经常耐受未来的疫苗剂量。出于这个原因,我们的目标是分享我们在佛罗伦萨迈耶儿童医院的经验,以提高对未来疫苗接种的潜在风险的认识,并讨论旨在预防它们的有价值的治疗策略,考虑到文学专家的建议。我们描述了一名18个月大的女性受斑丘疹性皮肤肥大细胞增多症多态变体影响的情况,该变体在第二剂(加强剂量)灭活的四价流感疫苗后24小时表现出广泛的大疱性皮肤反应。单剂量口服皮质类固醇治疗与倍他米松(0.1mg/kg)和口服抗组胺治疗与奥克他汀(1mg/kg/天)治疗一周,直到决议。据我们所知,在文学中,没有文献记载斑丘疹性皮肤肥大细胞增生症患者对流感疫苗的反应.随后,患者开始每天使用酮替芬进行背景治疗(0.05mg/kg,每天两次),一种非竞争性H1-抗组胺药,和肥大细胞稳定剂(双重活性)。使用H1受体拮抗剂(oxatomide,0.5mg/kg)在免疫前12小时给药,并在注射前2小时给予单剂量的倍他米松(0.05mg/kg)和另一剂量的奥克他米德(0.5mg/kg),以使患者能够继续进行预定的疫苗接种。的确,随后无反应报告.因此,根据我们的经验,酮替芬的背景疗法与由两剂奥克他汀和单剂倍他米松进行的术前用药方案相关,有助于其他疫苗的实施.我们建议在这些孩子身上,可以考虑在计划接种疫苗时采取预防措施的想法,无论疫苗的种类以及以前是否接受过相同剂量的疫苗。然而,需要达成国际共识,以管理患有肥大细胞增多症和先前对疫苗的不良反应的儿童的疫苗接种。
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.