FAILURE OF SULFITES TO PRODUCE CLINICAL-RESPONSES IN PATIENTS WITH SYSTEMIC MASTOCYTOSIS OR RECURRENT ANAPHYLAXIS - RESULTS OF A SINGLE-BLIND STUDY

[摘要] Although sulfite sensitivity can precipitate asthma in a subpopulation of subjects with asthma, its role in precipitating anaphylaxis or as a nonspecific mast cell degranulator in systemic mastocytosis has not been examined. To evaluate critically the importance of sulfites in these diseases, eight patients with systemic mastocytosis and 25 patients with unexplained, recurrent anaphylaxis were challenged in a single-blind fashion; sodium bisulfite in capsules was administered in increasing doses of 1, 5, 10, 25, 50, 100, and 200 mg every 30 minutes. On separate occasions a liquid suspension of 200 mg of sodium bisulfite was administered to one patient with systemic mastocytosis and nine patients with anaphylaxis. Vital signs, pulmonary function tests, plasma histamine levels, and clinical reactions were monitored. There were no observable responses in either the mastocytosis group or in 23 of 25 patients in the anaphylaxis group. Two patients in the anaphylaxis group with initial positive challenges had similar symptoms on subsequent placebo challenge. One subject with asthma and with a history suggestive of sulfite sensitivity responded to oral challenge with 5 mg of sodium bisulfite and 100 .mu.g of sodium bisulfite intradermally with a dramatic reduction in FEV, requiring treatment with bronchodilators. A comparison of baseline plasma histamine levels with those obtained after the sulfite challenge procedure in each category demonstrated a significant rise (p < 0.05) in the systemic mastocytosis group. The overall level of significance determined by applying paired sample t tests to the histamine data from all subjects was p < 0.01. These data indicate that, although sulfite challenges result in significant rises in plasma histamine, these increases were insufficient to cause symptoms in the patients with mastocytosis or recurrent anaphylasis. Thus, sulfite sensitivity appears to be rare in patients with systemic mastocytosis or unexplained anaphylaxis. However, the data confirm and support the concept that sulfite sensitivity is important in some subjects with asthma.

[发布日期] 1985-12-01