Systemic mastocytosis and medical marijuana
Pruritus, flushing, nausea, vomiting, diarrhea, abdominal pain, vascular instability
A 21-year-old college student with systemic mastocytosis uses inhaled medical marijuana to relieve symptoms and gain homeostasis.
Brief history and target symptomatology
Beginning in his teen years, this young man has had urticaria pigmentosa, allergy to multiple foods and food preservatives resulting in frequent flareups of abdominal pain, nausea, vomiting or diarrhea. Sunny, cold or hot weather could cause generalized arthralgia.
Previous and current conventional therapies
The patient still takes Gastrocrom (Cromolyn, a mast cell stabilizer) but believes that medical marijuana is the most important factor in his well-being. He carries with him at all times injectable epinephrine in case of anaphylactic reaction.
Clinical response to Cannabis
The patient's most frequent symptom is sudden bouts of gastrointestinal distress (pain, nausea, diarrhea). For the past 2 1/2 years, since he started using medical marijuana, he has had few flareups, when carefully avoiding known food allergens and other precipitants.
This patient most likely suffers from the indolent subtype of systemic mastocytosis. The pathologic manifestations of this disease are the abnormal accumulation of mast cells in the skin, G.I. tract, bone marrow, and lymph nodes and the frequent association with hematologic disorders. A genetic (proto-oncogene c-KIT) mutation is usually detectable in the mast cells and their precursors. Symptoms are due to the release from mast cells of leukotrienes which are responsible for contraction of smooth muscles, stimulation of vascular permeability, and attraction and activation of leukocytes; these are three to four orders of magnitude more potent than histamine. Counseling, prevention of exposure to mast cell secretory stimuli and symptomatic treatment are the mainstays of current patient management.
Reference: Hartmann. K, Bruns,S and Henz,B: Mastocytosis: Review of Clinical and Experimental Aspects. Journal of Investigative Dermatology Symposium Proceedings (2001) 6, 143–147
Usual method of Cannabis administration
Frequency of Usage: Time Per Day
Frequency of Usage: Days per Week