Allergic Rhinitis and Sensitization (160)Food Allergy and Anaphylaxis Research (135)Dermatology and Skin Diseases (130)Contact Dermatitis and Allergies (72)Urticaria and Related Conditions (35)
Bent RK, Varsanova I, Faihs V, Kugler C, Zink A, et al.
The journal of allergy and clinical immunology. In practice •
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. To determine the safety of food and drug OCT in patients with MC. 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. 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). 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.
Benders-Guedj M, Köberle M, Hofmann H, Biedermann T, Darsow U
Allergologie select •
Tick bite-induced IgE-mediated reactions to the oligosaccharide galactose α-1,3-galactose (alpha-gal) are increasingly recognized. This study investigated alpha-gal sensitization in three groups with different tick bite exposure. Specific IgE antibodies to alpha-gal and total IgE were investigated in 485 patients with Lyme borreliosis with different disease manifestations and compared to a control group of 200 randomly selected patients without increased exposure to tick bites. A group of 232 hunters and forest workers served as a model for multiple tick bites. Specific IgE (sIgE) antibodies to alpha-gal (> 0.1 kU/L) were found in 12.6% of all borreliosis samples compared to the control group with 9% (relative risk 1.4; 95% CI 0.85 - 2.3; not significant (n.s.). The highest prevalence of sIgE to alpha-gal was observed in hunters and forest service employees (22.8%, relative risk 2.5; 95% CI 1.5 - 4.2; p < 0.001). Higher age and elevated total IgE were also associated with alpha-gal sensitization. IgE sensitization to alpha-gal tends to be more frequent in tick-exposed patients with borreliosis than in controls (n.s.). Moreover, hunters and forest workers show an even higher rate of elevated IgE to alpha-gal. Thus, frequent tick contact may result in alpha-gal sensitization. In the area of Munich, the prevalence of alpha-gal sensitization appears lower than in the state of Baden-Württemberg and lower than in the USA, which may be due to the difference in tick species or the frequency of tick exposure. This study could show that alpha-gal sensitization and presumably alpha-gal syndrome does not seem to be a modern problem but existed already more than 30 years ago.