Anaphylaxis and systemic mastocytosis caused by Solenopsis invicta stings / Anafilaxia e mastocitose sistêmica ocasionada pela Solenopsis invicta

Indolent systemic mastocytosis is a rare disease characterized by an increased number of mast cells in the bone marrow and other tissues, such as the liver, spleen, lymph nodes, and skin. Patients with indolent systemic mastocytosis and high serum tryptase levels are at risk for Hymenoptera venom-induced anaphylaxis. Hymenoptera venom immunotherapy in patients with specific IgE is safe and effective. While some patients can receive ultra-rush venom immunotherapy with minimal side effects, omalizumab effectively protects against anaphylaxis during the build-up phase.

A mastocitose sistêmica indolente é uma doença rara caracterizada por um número aumentado de mastócitos na medula óssea e em outros tecidos, como fígado, baço, linfonodos e pele. Pacientes com mastocitose sistêmica indolente e altos níveis séricos de triptase correm risco de anafilaxia induzida pelo veneno dos Hymenoptera. A imunoterapia com veneno de himenópteros em pacientes com IgE específica é segura e eficaz. Embora alguns pacientes possam receber imunoterapia com veneno ultrarrápido com efeitos colaterais mínimos, o omalizumabe protegeu efetivamente contra a anafilaxia durante a fase de acúmulo.

Specific questionnaire detects a high incidence of intra-operative hypersensitivity reactions

OBJECTIVE: To assess the incidence of intra-operative immediate hypersensitivity reactions and anaphylaxis. METHODS: A cross-sectional observational study was conducted at the Department of Anesthesiology, University of São Paulo School of Medicine, Hospital das Clínicas, São Paulo, Brazil, from January to December 2010. We developed a specific questionnaire to be completed by anesthesiologists. This tool included questions about hypersensitivity reactions during anesthesia and provided treatments. We included patients with clinical signs compatible with immediate hypersensitivity reactions. Hhypersensitivity reactions were categorized according to severity (grades I-V). American Society of Anesthesiologists physical status classification (ASA 1-6) was analyzed and associated with the severity of hypersensitivity reactions. RESULTS: In 2010, 21,464 surgeries were performed under general anesthesia. Anesthesiologists answered questionnaires on 5,414 procedures (25.2%). Sixty cases of intra-operative hypersensitivity reactions were reported. The majority patients (45, 75%) had hypersensitivity reactions grade I reactions (incidence of 27.9:10,000). Fifteen patients (25%) had grade II, III or IV reactions (intra-operative anaphylaxis) (incidence of 7:10,000). No patients had grade V reactions. Thirty patients (50%) were classified as ASA 1. The frequency of cardiovascular shock was higher in patients classified as ASA 3 than in patients classified as ASA 1 or ASA 2. Epinephrine was administered in 20% of patients with grade III hypersensitivity reactions and in 50% of patients with grade II hypersensitivity reactions. CONCLUSIONS: The majority of patients had hypersensitivity reactions grade I reactions; however, the incidence of intra-operative anaphylaxis was higher than that previously reported in the literature. Patients with ASA 3 had more severe anaphylaxis; however, the use of epinephrine was not prescribed in all of these cases. Allergists and anesthesiologists should implement preventive measures to reduce the occurrence of anaphylaxis.

Incidência aumentada de haplótipo de HLA de classe II na anafilaxia grave secundária à carboplatina / Increased incidence of a class II HLA haplotype in severe anaphylaxis secondary to carboplatin

Objetivo: O papel de biomarcadores nas reações de hipersensibilidade a platinas tem sido estudado, e é conhecido que a presença da mutação do gene BRCA1/2 é fator de risco para reações de hipersensibilidade à carboplatina. A genotipagem de HLA de classes I e II auxilia na identificação de pacientes de risco para reações IgE-mediadas e mediadas por linfócitos T associadas a beta-lactâmicos e abacavir, respectivamente. Não são conhecidos alelos ou haplótipos de HLA mais prevalentes em pacientes alérgicos à carboplatina. O objetivo principal do estudo foi avaliar se alelos específicos de HLA de classe II são mais prevalentes em pacientes alérgicos à carboplatina submetidos à dessensibilização (DS). Método: Genotipagem de HLA de classe II realizada em 11 pacientes portadoras de neoplasias malignas tubo-ovarianas, alérgicas à carboplatina, e submetidas à DS, e em 12 pacientes tolerantes à carboplatina, por no mínimo oito ciclos. Analisou-se também a prevalência da mutação BRCA1/2 nos dois grupos estudados. Resultados: O alelo HLA-DRB1*15:01 foi mais prevalente entre as pacientes alérgicas (5/11; 45%) do que nos controles (1/12; 8,3%) (p = 0,06). O haplótipo de classe II DQA1*01:02-DQB1*06:02-DRB1*15:01 foi mais expresso no grupo de pacientes alérgicas. A mutação do BRCA1/2 mostrou-se mais prevalente no grupo alérgico. Conclusões: A identificação de pacientes de risco para reações alérgicas à carboplatina é de extrema importância com o uso crescente da medicação. A genotipagem de HLA e a pesquisa da mutação BRCA1/2 mostramse ferramentas promissoras que podem aumentar a segurança durante infusão regular de carboplatina e DS.

Objective: The role of biomarkers in hypersensitivity reactions (HSR) to platinum compounds has been studied, and the presence of BRCA1/2 gene mutation is known to be a risk factor for carboplatin HSR. Class I and II HLA genotyping helps identify patients at risk for IgE-mediated and T lymphocyte-mediated reactions associated with beta-lactams and abacavir, respectively. Associations between HLA alleles or haplotypes and carboplatin HSR are not known. The main objective of the present study was to evaluate whether specific class II HLA alleles are more prevalent in patients allergic to carboplatin who underwent rapid drug desensitization (RDD). Methods: Class II HLA genotyping was performed in 11 carboplatin-allergic patients with tubo-ovarian malignancies who were submitted to RDD, and in 12 patients who tolerated carboplatin, for at least eight cycles. The prevalence of the BRCA1/2 mutation was also analyzed in both groups. Results: The HLA-DRB1*15:01 allele was more prevalent among allergic patients (5/11; 45%) than in controls (1/12; 8.3%) (p = 0.06). Class II haplotype DQA1*01:02-DQB1*06:02-DRB1*15:01 and the BRCA1/2 mutation were also more prevalent in the allergic group. Conclusions: The identification of patients at risk for carboplatin HSR is of utmost importance, as the use of this medication is increasing. HLA genotyping and screening for the BRCA1/2 mutation are promising tools that may increase safety during regular carboplatin infusion and RDD.