TY - JOUR
T1 - Safety and Low Incidence of Anaphylaxis in Performing Oral Drug and Food Challenges in Mastocytosis
AU - Bent, Rebekka Karolin
AU - Varsanova, Ivana
AU - Faihs, Valentina
AU - Kugler, Claudia
AU - Zink, Alexander
AU - Jäger, Teresa
AU - Ring, Johannes
AU - Biedermann, Tilo
AU - Darsow, Ulf
AU - Brockow, Knut
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2025
Y1 - 2025
N2 - Background: Patients with mastocytosis (MC) have an increased risk of severe anaphylaxis. They report hypersensitivity reactions to drugs and food, but causality often remains questionable. Most allergy centers avoid oral challenge tests (OCT) in MC patients. Objective: To determine the safety of food and drug OCT in patients with MC. Methods: To evaluate the safety and outcome of challenges to drugs and food including food additives retrospectively, of 126 adult MC inpatients, 83 were suspected to have food or drug hypersensitivity and 445 OCTs were performed. History, clinical data, and allergy test results highlighting OCTs were analyzed. Results: Only 10 of 445 OCTs (2.2%) in nine patients resulted in anaphylaxis. Drugs elicited reactions in four of 170 patients (2.4%): two to acetylsalicylic acid (two in 39 patients tested; 5.1%), one to tramadol (one in 12; 8.3%), and one to flurbiprofen (100%). Anaphylaxis to food was recorded in six of 275 OCTs (2.2%); two of 48 (4.1%) to galactose-α-1,3-galactose, two to other foods, and two to sulfites. Flushing or diarrhea occurred owing to histamine in five of 48 patients (10.4%), but also in five of 50 placebo challenges (10.0%), strongly questioning its relevance. Patients with proven anaphylaxis had more bone marrow MC and higher basal serum tryptase (71.3 vs 44.3 μg/L; P < .05). Conclusions: Challenge-confirmed food and drug anaphylaxis was rare in MC patients. Results have to be interpreted cautiously because placebo reactions occurred. Severe anaphylaxis was infrequent but may occur and should be met by emergency preparedness.
AB - Background: Patients with mastocytosis (MC) have an increased risk of severe anaphylaxis. They report hypersensitivity reactions to drugs and food, but causality often remains questionable. Most allergy centers avoid oral challenge tests (OCT) in MC patients. Objective: To determine the safety of food and drug OCT in patients with MC. Methods: To evaluate the safety and outcome of challenges to drugs and food including food additives retrospectively, of 126 adult MC inpatients, 83 were suspected to have food or drug hypersensitivity and 445 OCTs were performed. History, clinical data, and allergy test results highlighting OCTs were analyzed. Results: Only 10 of 445 OCTs (2.2%) in nine patients resulted in anaphylaxis. Drugs elicited reactions in four of 170 patients (2.4%): two to acetylsalicylic acid (two in 39 patients tested; 5.1%), one to tramadol (one in 12; 8.3%), and one to flurbiprofen (100%). Anaphylaxis to food was recorded in six of 275 OCTs (2.2%); two of 48 (4.1%) to galactose-α-1,3-galactose, two to other foods, and two to sulfites. Flushing or diarrhea occurred owing to histamine in five of 48 patients (10.4%), but also in five of 50 placebo challenges (10.0%), strongly questioning its relevance. Patients with proven anaphylaxis had more bone marrow MC and higher basal serum tryptase (71.3 vs 44.3 μg/L; P < .05). Conclusions: Challenge-confirmed food and drug anaphylaxis was rare in MC patients. Results have to be interpreted cautiously because placebo reactions occurred. Severe anaphylaxis was infrequent but may occur and should be met by emergency preparedness.
KW - Allergy diagnosis
KW - Anaphylaxis
KW - Drugs
KW - Food
KW - Mastocytosis
KW - Oral provocation tests
UR - http://www.scopus.com/inward/record.url?scp=85214327227&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2024.10.044
DO - 10.1016/j.jaip.2024.10.044
M3 - Article
C2 - 39521340
AN - SCOPUS:85214327227
SN - 2213-2198
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
ER -