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

doi:10.1186/1710-1492-10-19

. 2014 Apr 24;10(1):19.

doi: 10.1186/1710-1492-10-19. eCollection 2014.

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

Cornelia S Seitz¹, Knut Brockow², Johannes Hain³, Axel Trautmann⁴

Affiliations

¹ Department of Dermatology and Allergy, University Hospital Göttingen, Göttingen, Germany.
² Department of Dermatology and Allergy, Biederstein, Technische Universität München, Munich, Germany.
³ Institute of Mathematics, Department of Statistics, University of Würzburg, Würzburg, Germany.
⁴ Department of Dermatology and Allergy, University Hospital Würzburg, Josef Schneider Strasse 2, Würzburg 97080, Germany.

PMID: 24782901
PMCID: PMC4002884
DOI: 10.1186/1710-1492-10-19

Free PMC article

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

Cornelia S Seitz et al. Allergy Asthma Clin Immunol. 2014.

Free PMC article

. 2014 Apr 24;10(1):19.

doi: 10.1186/1710-1492-10-19. eCollection 2014.

Authors

Cornelia S Seitz¹, Knut Brockow², Johannes Hain³, Axel Trautmann⁴

Affiliations

¹ Department of Dermatology and Allergy, University Hospital Göttingen, Göttingen, Germany.
² Department of Dermatology and Allergy, Biederstein, Technische Universität München, Munich, Germany.
³ Institute of Mathematics, Department of Statistics, University of Würzburg, Würzburg, Germany.
⁴ Department of Dermatology and Allergy, University Hospital Würzburg, Josef Schneider Strasse 2, Würzburg 97080, Germany.

PMID: 24782901
PMCID: PMC4002884
DOI: 10.1186/1710-1492-10-19

Abstract

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.

Keywords: Anaphylaxis; Drug allergy; Drug reaction; Mastocytosis; Non-steroidal anti-inflammatory drug; Pseudo-allergy.

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References

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. doi: 10.1034/j.1398-9995.2001.t01-1-00001.x. - DOI - PubMed
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1. 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. doi: 10.1164/ajrccm/137.4.847. - DOI - PubMed
1. 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. doi: 10.1111/j.1398-9995.1997.tb00182.x. - DOI - PubMed
1. 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. doi: 10.1111/j.1398-9995.2007.01569.x. - DOI - PubMed

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[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. doi: 10.1034/j.1398-9995.2001.t01-1-00001.x. - DOI - PubMed

[2] 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. doi: 10.1034/j.1398-9995.2001.t01-1-00001.x. - DOI - PubMed

[3] Simons FE. Anaphylaxis. J Allergy Clin Immunol. 2010;125:S161–S181. doi: 10.1016/j.jaci.2009.12.981. - DOI - PubMed

[4] Simons FE. Anaphylaxis. J Allergy Clin Immunol. 2010;125:S161–S181. doi: 10.1016/j.jaci.2009.12.981. - DOI - PubMed

[5] 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. doi: 10.1164/ajrccm/137.4.847. - DOI - PubMed

[6] 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. doi: 10.1164/ajrccm/137.4.847. - DOI - PubMed

[7] 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. doi: 10.1111/j.1398-9995.1997.tb00182.x. - DOI - PubMed

[8] 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. doi: 10.1111/j.1398-9995.1997.tb00182.x. - DOI - PubMed

[9] 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. doi: 10.1111/j.1398-9995.2007.01569.x. - DOI - PubMed

[10] 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. doi: 10.1111/j.1398-9995.2007.01569.x. - DOI - PubMed

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

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

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