The heterogeneous morphological, biochemical and functional characteristics of mast cells from different species and from different tissue sites in the same species have been described for over 30 years. Far from being mere histochemical or pharmacological curiosities these differences have far reaching implications for therapeutic practice. This review concentrates on two important areas affected by mast cell heterogeneity, those of adverse reactions to therapeutic agents and the efficacy of anti-allergy therapy. In vitro studies of preformed and de novo synthesised mediator release have demonstrated a wide variability in the response of basophils and isolated mast cells to anti-allergy drugs and therapeutic agents such as radiographic contrast media, general anaesthetics, opioids and muscle relaxants. This heterogeneity is not limited to the mast cell's tissue of origin as there is also variability in the response of basophils and mast cells from different donors to the same drug or agent. These data have considerable clinical implications for the study of adverse drug reactions and the design of novel anti-allergic drugs.
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