A new study published in the European Journal of Allergy and Clinical Immunology offers reassuring evidence that drug provocation testing (DPT) can be performed safely in people with mastocytosis. The findings suggest that many patients may be able to tolerate commonly used medications such as antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs) when testing is done under careful medical supervision.
People with systemic mastocytosis (SM) and other clonal mast cell disorders (CMD) face a well-documented risk of anaphylaxis. Drugs are among the most frequent triggers, along with insect stings and, less often, foods. Because of this, many people with SM may avoid a wide range of medications, sometimes unnecessarily, which can complicate treatment for infections, pain or inflammation.
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DPT is considered the gold standard method for diagnosing drug allergies. It involves administering a medication that may trigger a reaction or an alternative medication and gradually increasing the dose to determine if the medication is safe to use. For the study, a team of researchers from Italy evaluated 104 adults with CMD and 100 control patients with a history of drug hypersensitivity. Altogether, 250 DPTs were conducted in the CMD group and 231 in controls.
The results showed that reactions were rare in both groups. Among those with CMD, only one mild skin reaction occurred, compared to five in the control group. All were mild (Grade I) and resolved without complications. Importantly, no severe systemic reactions or anaphylaxis occurred during testing.
The most commonly tested drugs were antibiotics, like macrolide and quinolone, and NSAIDs, such as etoricoxib and nimesulide. Even aspirin and ibuprofen, which can trigger symptoms in some people with mast cell activation disease, were well tolerated in those who were tested.
The researchers concluded that DPTs are both safe and clinically valuable for people with clonal mast cell disorders, including SM, when performed by experienced teams in hospital settings.
“In patients with a history of drug reactions, the culprit drugs should be avoided, and an alternative should be tested with a DPT,” the authors wrote.
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