From the Pediatric Allergy and Clinical Immunology Department, Health Science University Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey.
Department of Genetics, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey.
Allergy Asthma Proc. 2019 Mar 1;40(2):123-128. doi: 10.2500/aap.2019.40.4201.
Cutaneous mastocytosis (CM) is a heterogeneous disease that commonly presents with skin lesions in childhood. In this study, we aimed to evaluate the clinical and laboratory test results of our patients with CM to ascertain prognostic factors by using patients' long-term follow-up results and to determine c-KIT (receptor tyrosine kinase) mutation from peripheral blood samples, which might be responsible for the etiopathogenesis of pediatric mastocytosis. The clinical observation data of 32 children who had been diagnosed with CM were retrospectively researched. Exon 8, 9, 11, 13, and 17 c-KIT gene locations were analyzed from DNA material that was obtained from peripheral blood samples of all the patients by using polymerase chain reaction analysis and automatic DNA sequencing. The tryptase level was higher in patients with familial cases and in cases of patients who had gastrointestinal mediator releasing symptoms (p = 0.017, p = 0.038, respectively). The use of clarithromycin and the use of vitamin D were determined as triggers for mediator release. Hypogammaglobulinemia was found in six patients (18.8%). Indoor tobacco exposure was seen to be higher in patients not in remission than in patients in remission (59.1% and 20%, respectively) (p = 0.040). Allergic diseases were observed in 80% of patients in complete remission and 22.7% of patients not in remission (p = 0.002). Concomitant allergic diseases were found to be good prognosis markers among pediatric patients with CM. No c-KIT mutation was discovered in any of the patients. In this study, tobacco exposure would seem to be a barrier for remission, and concomitant allergic diseases were seen to be a good prognosis marker. Evaluation of peripheral c-KIT mutation had no diagnostic contribution among pediatric patients with CM in contrast to adults.
皮肤肥大细胞增多症(CM)是一种异质性疾病,通常在儿童期表现为皮肤损伤。在这项研究中,我们旨在通过患者的长期随访结果评估我们的 CM 患者的临床和实验室检查结果,以确定预后因素,并从外周血样本中确定 c-KIT(受体酪氨酸激酶)突变,这可能是导致儿科肥大细胞增多症的病因。回顾性研究了 32 名被诊断为 CM 的儿童的临床观察数据。通过聚合酶链反应分析和自动 DNA 测序,从所有患者的外周血样本中提取 DNA 材料,分析 c-KIT 基因外显子 8、9、11、13 和 17 位置。家族性病例和存在胃肠道介质释放症状的病例患者的类胰蛋白酶水平较高(p = 0.017,p = 0.038)。使用克拉霉素和使用维生素 D 被确定为介质释放的触发因素。发现 6 名患者(18.8%)存在低丙种球蛋白血症。在未缓解的患者中,室内吸烟暴露的比例高于缓解的患者(分别为 59.1%和 20%)(p = 0.040)。在完全缓解的患者中有 80%和未缓解的患者中有 22.7%观察到过敏性疾病(p = 0.002)。在患有 CM 的儿科患者中,同时患有过敏性疾病被认为是良好的预后标志物。在任何患者中均未发现 c-KIT 突变。在这项研究中,吸烟暴露似乎是缓解的障碍,同时患有过敏性疾病被认为是良好的预后标志物。与成人相比,评估外周 c-KIT 突变对儿科 CM 患者没有诊断贡献。