A 25-Hour Fast Among Quiescent Hereditary Coproporphyria and Variegate Porphyria Patients is Associated With a Low Risk of Complications

• Published in: Rambam Maimonides medical journal 2023-01, Vol.14 (1), p.e0003
• Main Authors: Edel, Yonatan, Mamet, Rivka, Sagy, Iftach, Snast, Igor, Kaftory, Ran, Mimouni, Tomer, Levi, Assi
• Format: Article
• Language: English
• Subjects: attack; emergency department; fast; porphyria; yom kippur
• ISSN: 2076-9172; 2076-9172
• DOI: 10.5041/RMMJ.10490

In patients with acute hepatic porphyria (AHP), prolonged fasting is a known trigger of AHP attacks. Despite this, some Jewish AHP patients-mainly hereditary coproporphyria (HCP) and variegate porphyria (VP) patients-fast for 25 consecutive hours during the traditional Jewish holy day known as Yom Kippur. In this study, we evaluated the effect of the fast on these patients. A retrospective study and survey of AHP patients in Israel was carried out. Patients were asked whether they have fasted and whether any symptoms were induced by this fast. Patients' medical records were reviewed for an emergency department (ED) visit following Yom Kippur between 2007 and 2019. Only 3 acute intermittent porphyria (AIP) patients reported fasting; they were excluded from analysis. A total of 21 HCP patients and 40 VP patients completed the survey; 30 quiescent patients reported they fast, while 31 did not fast. The majority of fasting patients (96.67%) reported no symptoms following a fast. We found no statistically significant association between ED visits 1 week (0.26% in both fasting and non-fasting patients) or 1 month (2.1% visits in non-fasting versus 0.78% in fasting patients) following Yom Kippur. Of the symptomatic ED visits following a fast, none were defined as severe attacks. A 25-hour fast in stable HCP and VP patients did not increase the risk of an acute attack and can probably be regarded as safe.