Table 4.

Triggers for mast cell mediator release^*

Mechanical irritation of the skin (rubbing, scratching, friction)

Heat (e.g. hot shower), cold, sudden change of temperature

Physical exercise

Insect stings (e. g. bee and wasp stings)

Drugs (radiocontrast media, drugs used in general anaesthesia, codeine morphine, dextromethorphan, aspirin, and other analgesics)

Infection

Alcohol

^*Note not all patients with mastocytosis have reactions provoked by all factors. For example, many patients with mastocytosis tolerate radiocontrast media, anaesthesia, morphine, dextrometorphan, aspirin, and other analgesics. When in question, patients should undergo graded challenges to determine sensitivity.