Non-steroidal anti-inflammatory drug hypersensitivity: association with elevated basal serum tryptase?
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.
Department of Dermatology and Allergy, University Hospital Göttingen, Göttingen, Germany.
Cornelia S
CS
Seitz
Department of Dermatology and Allergy, Biederstein, Technische Universität München, Munich, Germany.
Knut
K
Brockow
Institute of Mathematics, Department of Statistics, University of Würzburg, Würzburg, Germany.
Johannes
J
Hain
Department of Dermatology and Allergy, University Hospital Würzburg, Josef Schneider Strasse 2, Würzburg 97080, Germany.
Axel
A
Trautmann
Anaphylaxis; Drug allergy; Drug reaction; Mastocytosis; Non-steroidal anti-inflammatory drug; Pseudo-allergy