title: Association of transient dermal mastocytosis and elevated plasma tryptase levels with development of adverse reactions after treatment of onchocerciasis with ivermectin.
abstract: To investigate the role of mast cells in treatment-associated adverse reactions in patients with onchocerciasis, changes in plasma tryptase levels and skin mast cell counts were examined in 2 groups of Onchocerca volvulus-infected subjects after ivermectin treatment. After treatment, an increase in tryptase levels was observed concurrent with the onset of blood eosinopenia and preceding the appearance of plasma eosinophil-derived neurotoxin (EDN) and interleukin-5. Tryptase levels were correlated with development of peripheral eosinopenia and markers of eosinophil activation and degranulation. Dermal mast cell numbers increased transiently at 24 h after treatment, preceding the onset of dermal eosinophil infiltration and the development of clinically apparent inflammation. Local reactions were strongly correlated with levels of plasma tryptase and EDN, and the severity of systemic reactions was correlated with levels of tryptase, EDN, and interleukin-5. The data indicate that mast cells play a role in initiation of tissue inflammatory reactions after ivermectin treatment of onchocerciasis.
authors.affiliation: Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA. pc102d@hotmail.com
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Cooper
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Schwartz
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Irani
authors.forename: Kwablah
authors.initials: K
authors.lastname: Awadzi
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Guderian
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Nutman
mesh_terms: D000818:Animals; D000871:Anthelmintics / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D004802:Eosinophilia / Q000139:chemically induced; D006801:Humans; D015848:Interleukin-5 / Q000097:blood; D007559:Ivermectin / Q000009:adverse effects*; D008209:Lymphedema / Q000139:chemically induced; D008407:Mast Cells / Q000469:parasitology / Q000502:physiology; D034701:Mastocytosis, Cutaneous / Q000139:chemically induced*; D009854:Onchocerca / Q000472:pathogenicity; D009855:Onchocerciasis / Q000188:drug therapy*; D012697:Serine Endopeptidases / Q000097:blood*; D053802:Tryptases
chemical_list: D000871:Anthelmintics; D015415:Biomarkers; D015848:Interleukin-5; D007559:Ivermectin; D012697:Serine Endopeptidases; D053802:Tryptases