Non-steroidal anti-inflammatory drug hypersensitivity: association with elevated basal serum tryptase?

Allergy, Asthma & Clinical Immunology

Cornelia S Seitz³  Knut Brockow¹  Johannes Hain²  Axel Trautmann⁴ 

[1] Department of Dermatology and Allergy, Biederstein, Technische Universität München, Munich, Germany

[2] Institute of Mathematics, Department of Statistics, University of Würzburg, Würzburg, Germany

[3] Department of Dermatology and Allergy, University Hospital Göttingen, Göttingen, Germany

[4] Department of Dermatology and Allergy, University Hospital Würzburg, Josef Schneider Strasse 2, Würzburg 97080, Germany

关键词: Pseudo-allergy;    Drug reaction;    Drug allergy;    Mastocytosis;    Non-steroidal anti-inflammatory drug;    Anaphylaxis;   

Others  :  791833
DOI  :  10.1186/1710-1492-10-19

 received in 2014-01-15, accepted in 2014-03-30,  发布年份 2014

【 摘 要 】

Background

It is hypothesized that because of higher mast cell numbers and mediator release, mastocytosis predisposes patients for systemic immediate-type hypersensitivity reactions to certain drugs including non-steroidal anti-inflammatory drugs (NSAID).

Objective

To clarify whether patients with NSAID hypersensitivity show increased basal serum tryptase levels as sign for underlying mast cell disease.

Methods

As part of our allergy work-up, basal serum tryptase levels were determined in all patients with a diagnosis of NSAID hypersensitivity and the severity of the reaction was graded. Patients with confirmed IgE-mediated hymenoptera venom allergy served as a comparison group.

Results

Out of 284 patients with NSAID hypersensitivity, 26 were identified with basal serum tryptase > 10.0 ng/mL (9.2%). In contrast, significantly (P = .004) more hymenoptera venom allergic patients had elevated tryptase > 10.0 ng/mL (83 out of 484; 17.1%). Basal tryptase > 20.0 ng/mL was indicative for severe anaphylaxis only in venom allergic subjects (29 patients; 4x grade 2 and 25x grade 3 anaphylaxis), but not in NSAID hypersensitive patients (6 patients; 4x grade 1, 2x grade 2).

Conclusions

In contrast to hymenoptera venom allergy, NSAID hypersensitivity do not seem to be associated with elevated basal serum tryptase levels and levels > 20 ng/mL were not related to increased severity of the clinical reaction. This suggests that mastocytosis patients may be treated with NSAID without special precautions.

【 授权许可】

   
2014 Seitz et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, Kowalski ML, Mygind N, Ring J, van Cauwenberge P, van Hage-Hamsten M, Wüthrich B: A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 2001, 56:813-824.
• [2]Simons FE: Anaphylaxis. J Allergy Clin Immunol 2010, 125:S161-S181.
• [3]Ferreri NR, Howland WC, Stevenson DD, Spiegelberg HL: Release of leukotrienes, prostaglandins, and histamine into nasal secretions of aspirin-sensitive asthmatics during reaction to aspirin. Am Rev Respir Dis 1988, 137:847-854.
• [4]Ordoqui E, Zubeldia JM, Aranzabal A, Rubio M, Herrero T, Tornero P, Rodriguez VM, Prieto A, Baeza ML: Serum tryptase levels in adverse drug reactions. Allergy 1997, 52:1102-1105.
• [5]Brockow K, Jofer C, Behrendt H, Ring J: Anaphylaxis in patients with mastocytosis: a study on history, clinical features and risk factors in 120 patients. Allergy 2008, 63:226-232.
• [6]Brockow K, Bonadonna P: Drug allergy in mast cell disease. Curr Opin Allergy Clin Immunol 2012, 12:354-360.
• [7]Schubert B, Grosse Perdekamp MT, Pfeuffer P, Raith P, Bröcker EB, Trautmann A: Nonsteroidal anti-inflammatory drug hypersensitivity: fable or reality? Eur J Dermatol 2005, 15:164-167.
• [8]Mertes PM, Malinovsky JM, Jouffroy L, Aberer W, Terreehorst I, Brockow K, Demoly P: Reducing the risk of anaphylaxis during anesthesia: 2011 updated guidelines for clinical practice. J Investig Allergol Clin Immunol 2011, 21:442-453.
• [9]Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, Bircher A, Blanca M, Bonadonna B, Campi P, Demoly P: Skin test concentrations for systemically administered drugs - an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy 2013, 68:702-712.
• [10]Brockow K, Romano A, Blanca M, Ring J, Pichler W, Demoly P: General considerations for skin test procedures in the diagnosis of drug hypersensitivity. Allergy 2002, 57:45-51.
• [11]Brown SG: Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol 2004, 114:371-376.
• [12]Schwartz LB, Bradford TR, Rouse C, Irani AM, Rasp G, Van der Zwan JK, Van der Linden PW: Development of a new, more sensitive immunoassay for human tryptase: use in systemic anaphylaxis. J Clin Immunol 1994, 14:190-204.
• [13]Valent P, Akin C, Escribano L, Fodinger M, Hartmann K, Brockow K, Castells M, Sperr WR, Kluin-Nelemans HC, Hamdy NA, Lortholary O, Robyn J, van Doormaal J, Sotlar K, Hauswirth AW, Arock M, Hermine O, Hellmann A, Triggiani M, Niedoszytko M, Schwartz LB, Orfao A, Horny HP, Metcalfe DD: Standards and standardization in mastocytosis: consensus statements on diagnostics, treatment recommendations and response criteria. Eur J Clin Invest 2007, 37:435-453.
• [14]Valent P, Akin C, Arock M, Brockow K, Butterfield JH, Carter MC, Castells M, Escribano L, Hartmann K, Lieberman P, Nedoszytko B, Orfao A, Schwartz LB, Sotlar K, Sperr WR, Triggiani M, Valenta R, Horny HP, Metcalfe DD: Definitions, criteria and global classification of mast cell disorders with special reference to mast cell activation syndromes: a consensus proposal. Int Arch Allergy Immunol 2012, 157:215-225.
• [15]Kowalski ML, Asero R, Bavbek S, Blanca M, Blanca-Lopez N, Bochenek G, Brockow K, Campo P, Celik G, Cernadas J, Cortellini G, Gomes E, Nizankowska-Mogilnicka E, Romano A, Szczeklik A, Testi S, Torres MJ, Wöhrl S, Makowska J: Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs. Allergy 2013, 68:1219-1232.
• [16]Haeberli G, Brönnimann M, Hunziker T, Müller U: Elevated basal serum tryptase and hymenoptera venom allergy: relation to severity of sting reactions and to safety and efficacy of venom immunotherapy. Clin Exp Allergy 2003, 33:1216-1220.
• [17]Bonadonna P, Perbellini O, Passalacqua G, Caruso B, Colarossi S, Dal Fior D, Castellani L, Bonetto C, Frattini F, Dama A, Martinelli G, Chilosi M, Senna G, Pizzolo G, Zanotti R: Clonal mast cell disorders in patients with systemic reactions to Hymenoptera stings and increased serum tryptase levels. J Allergy Clin Immunol 2009, 123:680-686.
• [18]Rueff F, Przybilla B, Bilo MB, Müller U, Scheipl F, Aberer W, Birnbaum J, Bodzenta-Lukaszyk A, Bonifazi F, Bucher C, Campi P, Darsow U, Egger C, Haeberli G, Hawranek T, Kucharewicz I, Kuchenhoff H, Lang R, Quercia O, Reider N, Severino M, Sticherling M, Sturm GJ, Wüthrich B: Predictors of side effects during the buildup phase of venom immunotherapy for Hymenoptera venom allergy: the importance of baseline serum tryptase. J Allergy Clin Immunol 2010, 126:105-111.
• [19]Position paper: Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol 2010, 105:259-273.
• [20]Gonzalez-Quintela A, Vizcaino L, Gude F, Rey J, Meijide L, Fernandez-Merino C, Linneberg A, Vidal C: Factors influencing serum total tryptase concentrations in a general adult population. Clin Chem Lab Med 2010, 48:701-706.
• [21]Alvarez-Twose I, Gonzalez de Olano D, Sanchez-Munoz L, Matito A, Esteban-Lopez MI, Vega A, Mateo MB, de Durana MD AD, de la Hoz B, Del Pozo Gil MD, Caballero T, Rosado A, Sanchez Matas I, Teodosio C, Jara-Acevedo M, Mollejo M, Garcia-Montero A, Orfao A, Escribano L: Clinical, biological, and molecular characteristics of clonal mast cell disorders presenting with systemic mast cell activation symptoms. J Allergy Clin Immunol 2010, 125:1269-1278.
• [22]Kowalski ML, Makowska JS, Blanca M, Bavbek S, Bochenek G, Bousquet J, Bousquet P, Celik G, Demoly P, Gomes ER, Nizankowska-Mogilnicka E, Romano A, Sanchez-Borges M, Sanz M, Torres MJ, De Weck A, Szczeklik A, Brockow K: Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, diagnosis and management. Allergy 2011, 66:818-829.