对肥大细胞增多症患者进行口服药物和食物挑战安全且过敏性休克发生率低。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-02-01 DOI:10.1016/j.jaip.2024.10.044

Rebekka Karolin Bent MD, Ivana Varsanova MD, Valentina Faihs MD, Claudia Kugler RND, Alexander Zink MD, Teresa Jäger MD, Johannes Ring MD, Tilo Biedermann MD, Ulf Darsow MD, Knut Brockow MD

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引用次数: 0

摘要

背景：肥大细胞增多症（MC）患者发生严重过敏性休克的风险增加。他们会报告对药物和食物的超敏反应，但因果关系往往仍值得怀疑。大多数过敏中心都避免对 MC 患者进行口服挑战试验 (OCT)：目的：确定在 MC 患者中进行食物和药物 OCT 的安全性：为了回顾性评估药物和食物（包括食品添加剂）挑战的安全性和结果，在 126 名成年 MC 住院患者中，有 83 名患者怀疑对食物或药物过敏，共进行了 445 次 OCT。对病史、临床数据和过敏测试结果进行了分析：结果：在 445 次 OCT 中，只有 9 名患者中的 10 次（2.2%）导致过敏性休克。4/170（2.4%）名患者对药物产生反应：两名患者对乙酰水杨酸产生反应（2/39 名接受测试的患者，5.1%），一名对曲马多产生反应（1/12，8.3%），一名对氟比洛芬产生反应（1/1）。275 例 OCT 中有 6 例（2.2%）对食物过敏；48 例中有 2 例（4.1%）对α-gal 过敏，2 例对其他食物过敏，2 例对亚硫酸盐过敏。5/48（10.4%）的患者对组胺过敏，但也有5/50（10.0%）的患者对安慰剂过敏，这对组胺过敏的相关性提出了强烈质疑。经证实的过敏性休克患者的骨髓 MC 增高，基础血清胰蛋白酶升高（71.3ug/l 对 44.3ug/l；p 结论：经挑战证实的食物和药物过敏性休克在MC患者中很少见。由于安慰剂反应确实存在，因此必须谨慎解释结果。严重的过敏性休克很少发生，但有可能发生，应做好应急准备。

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Safety and Low Incidence of Anaphylaxis in Performing Oral Drug and Food Challenges in Mastocytosis

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.

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.