Golf balls at injection site with hive.

[Pamela Hughes]

Question:  Ta1:   First shot had a hive over the site,  resolved in 2 hours.  Second Shot:  Hive that lasted about a week, Red and pruritic.  and now 2 weeks later left with a Golf ball size knot below it..  Two different sites, 2 knots and still quite pruritic.  Has anyone seen this?  Thoughts?

The Ta1 is from  a good source Pharmacy that you all use..  ?

Thanks.

 

 

[Dwight McKee]

Think Mast Cell Activation syndrome when you see this sort of reaction–inquire about other inflammatory/allergic symptoms in past from various triggers. MCAS can also be acquired (or worsened) from significant immune stressors such as mold, lyme, CV19, etc. Pathophysiology is an acquired clone of mast cells with somatic mutations in Kit receptor, making the cell unstable. Wherever the unstable mast cells congregate, and which spectrum of their over 1000 inflammatory mediators (best known being histamine, but they also can release heparin and a thousand others), defines the range of symptoms that present.

Basic treatment is H1 and H2 blockers, oral cromolyn, and mast cell stabilizers (can get ketotifen compounded in 1 mg capsules, taken 2-3 times per day, which is H1 blocker + mast cell stabilizer. Quercetin and ascorbic acid, palmitoylethanolamide are also good mast cell stabilizers. Search web for MCAS for papers that include Afrin and Moldering, for many aspects of this little recognized, but prevalent disease. Molderings research studying mutations in KIT receptor in Germany suggest a prevalence of nearly 15% in the population.

[Pamela Hughes]

Thanks, I am familiar with MCAS,  I am treating them for Mold and Lyme..  so makes sense..  Pt is on quercetin given COVID prevention with zinc..  Will look to add in more mast cell stabilization and antihistamines to see if the knots/pruritus will improve.  No other symptoms of MCAS though..  would you think that the MCAS would be more active diffusely versus such a local reaction?  Thanks for your help.

 

 

[William Seeds, MD]

@pamelahughesdogmail-com @dlmckeemdgmail-com reply from dr. seeds! 3rd question!

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