Comparison of CD63 Upregulation Induced by NSAIDs on Basophils and Monocytes in Patients with NSAID Hypersensitivity

Abstract

Background. An in vitro basophil activation test, based on the detection of CD63 upregulation induced by NSAIDs, has been described. Its clinical significance remains controversial. Objectives. In patients with a history of nonallergic NSAID hypersensitivity, stratified according to the severity of the symptoms, to assess with NSAIDs the predictive value of basophil (BAT) and monocyte (MAT) activation tests. Patients/Methods. Sixty patients who had NSAIDs-induced or exacerbated urticaria/angiooedema and 20 controls was included. After incubation with NSAIDs or acetaminophen, leukocytes were analysed for CD63 upregulation. Results. With aspirin, the sensitivity (37%) and specificity (90%) of BAT agree with already published results. In contrast, when patients had had cutaneous and visceral reactions, the frequency of positive BAT 14/22 (64%, P < 0.001) or MAT 10/22 (46%, P < 0.01) were increased. Conclusions. Positive tests were more frequent among patients having a severe hypersensitivity contrasting with the other patients who had results similar to controls.

The Basophil Activation Test Is Safe and Useful for Confirming Drug-Induced Anaphylaxis

“…In a comparative study of the sensitivity of CD63 and CD203c in IgE-mediated amoxicillin allergies, CD203c sensitivity is superior to CD63 11. In contrast, patients with non-allergic NSAID hypersensitivity upregulate CD63 expression more frequently than CD203c expression 12. In this study, basophils of patients with cefaclor-induced anaphylaxis upregulated CD203c, but not CD63.…”

Update on the Performance and Application of Basophil Activation Tests

“…In confirmed IgE-mediated amoxicillin allergy, the sensitivity for CD203c was found to be far superior to that of CD63 (60 vs. 20 %) [22]. In contrast, the same group demonstrated that CD63 expression was up-regulated more frequently than CD203c in patients with non-allergic NSAID hypersensitivity [27]. In patients with venom hypersensitivity, CD203c and CD63 were found to have similar kinetics, with maximum expression detected after 20 min of allergen stimulation.…”

“…In addition, 22 of these patients had hypotension, laryngeal edema, dyspnea, abdominal pain, vomiting, or diarrhea after NSAID intake. They found that the sensitivity among those patients without the visceral symptoms was only 21 %, but this increased to 64 % among those with more severe reactions [27]. Similarly, Korosec et al demonstrated that the BAT among NSAID-intolerant patients may only have diagnostic value for those with anaphylactoid reactions rather than those with asthma/rhinitis symptoms [30].…”

In vitro Diagnosis of Immediate Drug Hypersensitivity: Should We Go with the Flow?

“…As displayed in tables, the technique has mainly been applied to document allergy to NMBAs (table 1) [8,9,10,11,12,13,14,15,16], antibiotics like β-lactam antibiotics and quinolones (table 2) [17,18,19,20,21,22,23,24,25,26,27,28,29,30], aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs; table 3) [31,32,33,34,35,36,37,38,39,40,41,42,43,44,45], and iodinated radiocontrast media (RCM; table 4) [46,47,48]. In general, the sensitivity of the assay varies between 50 and 60%, whereas specificity easily attains 80%, except for quinolones and NSAIDs (see below).…”