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Oral Challenge Tests Reveal the Rarity of Food, Drug Anaphylaxis in Mastocytosis
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Key Takeaways
- Anaphylaxis in mastocytosis patients is rare, with only 2.2% of oral challenge tests resulting in such reactions.
- Most patients with mastocytosis do not have true drug or food allergies, and many self-reported allergies are unconfirmed.
Rebekka Karolin Bent, MD
Credit: ResearchGate
A study found challenge-confirmed food and drug anaphylaxis was rare in patients with mastocytosis.1
“Our results do not support general elimination diets or drug avoidance in patients with MC who do not have a history of DH or FH, although it may be advisable to give the first tablet of an NSAID that was not previously tolerated under medical supervision,” wrote investigators, led by Rebekka Karolin Bent, MD, from the department of dermatology and allergy Biederstein, from Technical University of Munich in Germany.
A retrospective study published in 2024 with 2 large cohorts (470 patients aged ≥ 18 years) found the presence of drug-induced anaphylaxis in mastocytosis tends to be greater than the general population but is overall low.2 Patients with mastocytosis have an increased risk of severe anaphylaxis, with many having hypersensitivity reactions to drugs and food.1 However, many allergy centers avoid oral challenge tests in patients with mastocytosis, so investigators wanted to determine the safety of food and drug oral challenge tests in this patient population.
Among 128 inpatients with mastocytosis, 83 were suspected to have food or drug hypersensitivity, resulting in 445 oral challenge tests. Investigators analyzed history, clinical data, and allergy test results. The sample included 37 females, and the median age was 61.1 years.
Only 10 of 445 oral challenge tests (2.2%) led to anaphylaxis. Drug-related reactions, such as from acetylsalicylic acid, tramadol, and flurbiprofen, occurred in 170 patients. Food-related anaphylaxis occurred in 6 oral challenge tests; these foods contained either galactose-α-1,3-galactose, sulfites, or other ingredients.
Severe anaphylaxis occurred only in 3 patients: 2 to α-1,3-galactose and 1 to acetylsalicylic acid. The number of patients with drug or food-related reactions was comparable to those after placebo oral challenge tests. The most common reactions were pruritus (n = 6), heat sensation (n = 5), flush (n = 5), and dizziness (n = 4).
Histamine led to flushing or diarrhea in 5 patients during oral challenge tests and 5 on 50 placebo challenges. The study also found that patients with confirmed anaphylaxis had more bone marrow (P < .0001) and greater basal serum tryptase (71.3 vs 44.3 μg/L; P < .05).
The study ultimately revealed that most patients did not have true drug or food allergies. Among all the oral challenge tests performed, 96.6% showed no hypersensitivity and 97.8% showed no anaphylaxis.
Although a few individuals reacted to specific triggers such as pork kidney, the overall risk of severe allergic reactions was not significantly greater than in the general population. Medications including codeine and antibiotics, often thought to trigger reactions, were well tolerated.
Moreover, many self-reported allergies to food additives such as sulfites and histamine were not confirmed by testing. Nearly 40% of patients had reactions to placebos, indicating stress and anticipation may influence symptoms.
The study suggests people with mastocytosis do not need to automatically avoid specific foods or medications. Investigators emphasized the importance of proper allergy testing to ensure patient safety and prevent unnecessary dietary and medication restrictions.
“Taken together, the incidents of anaphylaxis after OCT were few (four in 170; 2.4%), and we cannot confirm a substantially higher risk in MC compared with the normal population, although the current data need to be confirmed in further studies,” investigators wrote. “In cases of reasonable suspicion, allergy testing can be performed in patients with MC to identify the trigger and provide alternative medication.”
References
Bent RK, Varsanova I, Faihs V, Kugler C, Zink A, Jäger T, Ring J, Biedermann T, Darsow U, Brockow K. Safety and Low Incidence of Anaphylaxis in Performing Oral Drug and Food Challenges in Mastocytosis. J Allergy Clin Immunol Pract. 2025 Feb;13(2):407-417. doi: 10.1016/j.jaip.2024.10.044. Epub 2024 Nov 7. PMID: 39521340.
Beyens M, Sabato V, Ebo DG, Zaghmout T, Gülen T. Drug-Induced Anaphylaxis Uncommon in Mastocytosis: Findings From Two Large Cohorts. J Allergy Clin Immunol Pract. 2024 Jul;12(7):1850-1862.e1. doi: 10.1016/j.jaip.2024.03.040. Epub 2024 Mar 29. PMID: 38556047.
