Jarkvist Jesper, Brockow Knut, Gülen Theo
Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Mastocytosis Center Karolinska, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany.
J Allergy Clin Immunol Pract. 2020 Oct;8(9):3093-3101. doi: 10.1016/j.jaip.2020.05.044. Epub 2020 Jun 10.
Patients with mastocytosis have an increased risk for severe anaphylaxis, particularly to Hymenoptera venoms. These patients may also develop more often systemic hypersensitivity reactions to certain foods. However, this issue has not been systematically investigated.
To determine prevalence and severity of food hypersensitivity (FH) reactions among patients with clonal mast cell disorders (CMDs).
A retrospective study was conducted among 204 (age ≥18 years) consecutive patients who presented with confirmed CMD (170 with mastocytosis and 34 with monoclonal mast cell activation syndrome). All patients underwent thorough allergy workup where self-reported FH reactions were evaluated.
The prevalence of self-reported FH was 20.6%. The frequency of immunologically mediated reactions was uncommon, because only 3.4% were confirmed by relevant history and IgE sensitization. Among patients with FH, 5 had severe anaphylaxis corresponding to an overall prevalence of 2.5%. Most symptoms were restricted to skin (86%), followed by gastrointestinal tract symptoms (45%)-similar to symptoms that occur in patients with mastocytosis also without food intake. Nuts, spicy foods, seafood, and alcohol were the most common incriminated elicitors. There was no significant difference between the groups regarding age, sex, atopic status, or IgE levels.
Anaphylaxis from foods in mastocytosis does exist and is severe, although foods are less frequent elicitors than insect venoms. Furthermore, the frequency of overall FH reactions is comparable with that in the general population and most reactions are mild, nonallergic, and unconfirmed. Consequently, our results do not support the elimination of any diet in patients with CMD without a history of FH.
肥大细胞增多症患者发生严重过敏反应的风险增加，尤其是对膜翅目昆虫毒液过敏。这些患者对某些食物也更易发生全身性过敏反应。然而，这一问题尚未得到系统研究。
确定克隆性肥大细胞疾病（CMD）患者中食物过敏（FH）反应的患病率和严重程度。
对204例（年龄≥18岁）确诊为CMD的连续患者（170例肥大细胞增多症患者和34例单克隆肥大细胞活化综合征患者）进行了一项回顾性研究。所有患者均接受了全面的过敏检查，对自我报告的FH反应进行了评估。
自我报告的FH患病率为20.6%。免疫介导反应的发生率并不常见，因为只有3.4%通过相关病史和IgE致敏得到证实。在FH患者中，5例发生严重过敏反应，总体患病率为2.5%。大多数症状局限于皮肤（86%），其次是胃肠道症状（45%），这与无食物摄入的肥大细胞增多症患者出现的症状相似。坚果、辛辣食物、海鲜和酒精是最常见的诱发因素。两组在年龄、性别、特应性状态或IgE水平方面无显著差异。
肥大细胞增多症患者因食物引起的过敏反应确实存在且严重，尽管食物作为诱发因素的频率低于昆虫毒液。此外，总体FH反应的频率与普通人群相当，且大多数反应为轻度、非过敏性且未经证实。因此，我们的结果不支持对无FH病史的CMD患者进行任何饮食限制。
