Cysteinyl‐leukotriene release test (CAST) in the diagnosis of immediate drug reactions

Lebel, B.; Messaad, D.; Kvedarienė, Violeta; Rongier, M.; Bousquet, Jean; Demoly, Pascal

doi:10.1034/j.1398-9995.2001.00103.x

Cited by 67 publications

(49 citation statements)

References 23 publications

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“…There are currently no sIgE assays for ASA or NSAID available. The diagnostic value of histamine and cys-LT release assays (135)(136)(137) and flow-assisted quantification of in vitro activated basophils (138,139) remains to be established. In our department patients with hypersensitivity reactions from ASA and NSAID are challenged with incremental doses of a selective COX-2 inhibitor, and some positive provocations have been observed.…”

Section: Aspirin and Other Nonsteroidal Anti-inflammatory Drugsmentioning

confidence: 99%

Anaphylaxis during anaesthesia: diagnostic approach

Ebo¹,

Fisher²,

Hagendorens³

et al. 2007

Allergy

195

197

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Anaesthesiologists administer several drugs while providing general anaesthesia. Many of these drugs can elicit adverse drug reactions that fall apart into two major types. First, reactions that are usually dose-dependent and related to the pharmacological properties of the drug and/or its metabolites. Second, reactions that are unrelated to the drug's pharmacological characteristics and that are less dose-dependent. These reactions comprise drug intolerance, idiosyncratic reactions and drug-induced immune-mediated allergic and nonimmune-mediated so-called pseudo-allergic or anaphylactoid reactions. The terms anaphylactic and anaphylactoid, however, have been used inconsistently in the literature. Therefore, the nomenclature task force set up by the European Academy of Allergy and Immunology (EAACI) has proposed that anaphylactic-type reactions should be reclassified into allergic anaphylaxis and nonallergic anaphylaxis. Allergic anaphylaxis being further subdivided in IgE-mediated and non-IgE-mediated reactions (1).The exact prevalence of anaphylaxis during anaesthesia is difficult to ascertain. The estimated overall frequency has been reported to vary between 1 in 3500 and 1 in 13 000 procedures in French series (2, 3) and between 1 in 10 000 and 1 in 20 000 in an Australian study (4). The clinical manifestation of these reactions is not infrequently an almost immediate generalized response with bronchospasm and hypotension. The degree of severity varies and does not allow differentiation between an IgE-mediated or non-IgE mediated reaction resulting from nonspecific mediator release (5). The mortality from these reactions is in the range from 3 to 6%, and an additional 2% of patients experience significant residual brain damage (4).Diagnosis of anaphylaxis during anaesthesia is not always straightforward. It can be hampered as a broad spectrum of different drugs can elicit heterogeneous allergic and nonallergic reactions with distinct and sometimes unclear pathological mechanisms. Problems are certainly compounded as multiple drugs need to be administered during general anaesthesia. In addition, nonanaesthesia related drugs or procedures (e.g. disinfection) are sometimes administered/performed in the perioperative period and can also be the cause of an allergic reaction.In addition, none of the available diagnostic tests demonstrates absolute accuracy. False-positive test Correct management of anaphylaxis during anaesthesia requires a multidisciplinary approach with prompt recognition and treatment of the acute event by the attending anaesthesiologist, and subsequent determination of the responsible agent(s) with strict avoidance of subsequent administration of all incriminated and/or cross-reacting compounds.However, correct identification of the causative compound(s) and safe alternatives is not always straightforward and, too often, not done.This review is not intended to discuss acute management of anaesthesia-related anaphylaxis but summarizes the major causes of anaphylaxis during anaesthesia and the di...

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Section: Aspirin and Other Nonsteroidal Anti-inflammatory Drugsmentioning

confidence: 99%

Anaphylaxis during anaesthesia: diagnostic approach

Ebo¹,

Fisher²,

Hagendorens³

et al. 2007

Allergy

195

197

View full text Add to dashboard Cite

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“…Indeed, classical allergy cellular tests, like histamine release, have yielded mostly negative results in ASA/NSAID hypersensitivity [31, 32]. In the early 1990s, however, with the advent of the cellular allergen stimulation test (CAST) based on the release of sLTs by activated blood basophils [33] and of the flowcytometric evaluation of basophil activation [5, 34], the dogma has been challenged.…”

Section: Introductionmentioning

confidence: 99%

A New Combined Test with Flowcytometric Basophil Activation and Determination of Sulfidoleukotrienes Is Useful for in vitro Diagnosis of Hypersensitivity to Aspirin and other Nonsteroidal Anti-Inflammatory Drugs

Sánz

Gamboa

Weck

2005

Int Arch Allergy Immunol

105

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Background: We assessed whether nonsteroidal anti-inflammatory drugs (NSAIDs) may provoke blood basophil activation in vitro in aspirin- and NSAID-hypersensitive patients, as detected by a flowcytometric technique using the CD63 marker – flowcytometric basophil activation test (FAST) assay – in addition to the sulfidoleukotriene (sLT) release – the cellular allergen stimulation test (CAST). Methods: Sixty aspirin- and/or NSAID-hypersensitive patients were studied. Thirty control patients without history and negative provocation challenge were also included. The percentage of activated basophils after in vitro stimulation with NSAIDs at 3 different concentrations was evaluated by an anti-CD63 phycoerythrin conjugate (FAST assay) and the amount of sLTs released in the cell supernatant by ELISA (CAST assay). Results: For aspirin, the FAST indicated a sensitivity of 41.7%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 99.4%; for paracetamol 11.7 and 100%, for metamizol 15 and 100%, for diclofenac 43.3 and 93.3%, and for naproxen 54.8 and 74.1%. Many patients showed positive tests to more than 1 NSAID. When considering the first 4 NSAIDs, the global sensitivity increased to 66.7%, while the specificity remained at 93.3%. The addition of the CAST results still increased the sensitivity up to 73.3%, but with a decrease of the specificity to 71.4%. Conclusions: The FAST shows a high percentage of positive reactions, which may reach 60–70% when 4 NSAIDs are tested and even 88% when the test is performed within 1 month of the last clinical drug exposure and reaction. The test has a high specificity above 90%. The addition of sLT determinations yields additional information in a few isolated cases. It is suggested that this test, when properly used, may help avoid some cumbersome and dangerous provocation challenges.

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“…Parfois, lorsque le médicament n'est pas disponible sous une forme réactive adéquate, c'est-à-dire que seuls ses dérivés métaboliques sont immunogènes (anti-inflammatoires non sté-roïdiens, anesthésiques locaux, antibiotiques autres que les pénicil-lines…), ou lorsque les tests cutanés sont négatifs (cas des pénicillines, notamment), seuls les tests réalistes de provocation permettent de poser le diagnostic. Ils sont réalisés à distance (au moins un mois) de l'épisode et utilisent le médicament [47], mais ne sont pas assez sensibles pour les autres médicaments [48]. Compte tenu du faible nombre de basophiles circulants, les tests de dégranulation des polynucléaires basophiles ne sont pas fiables.…”

Section: Démarche Diagnostique Stéréotypéeunclassified

“…Ils ont été remplacés par l'étude de l'expression à leur surface de marqueurs d'activation, parmi lesquels le CD63. Les tests de libération de sulfidoleucotriènes, proposés à la fois dans l'allergie dépendante des IgE et dans les fausses allergies par libération de ces médiateurs (comme avec l'aspirine, par exemple), ne permettent pas encore un diagnostic suffisamment fiable [48]. Devant une réaction clinique aiguë, les dosages sanguins d'histamine ou de tryptase et les dosages urinaires de méthylhistamine précisent le rôle des polynucléaires basophiles et des mastocytes, quelle que soit la cause de la dégranulation.…”

Section: Démarche Diagnostique Stéréotypéeunclassified