Diagnosis of neuromuscular blocking agent hypersensitivity reactions using cytofluorimetric analysis of basophils

Kvedarienė, Violeta; Kamey, S.; Ryckwaert, Yves; Rongier, M.; Bousquet, Jean; Demoly, Pascal; Arnoux, B.

doi:10.1111/j.1398-9995.2006.00978.x

Cited by 100 publications

(82 citation statements)

References 24 publications

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“…ST should be done within 4-6 weeks after the reaction and their sensitivity decreases over time; this decrease is faster for betalactams than for NMBAs (grade of recommendation, D) [114,115].…”

Section: Skin Testsmentioning

confidence: 99%

Practical Guidelines for Perioperative Hypersensitivity Reactions

Laguna¹,

Archilla²,

Doña³

et al. 2018

J Investig Allergol Clin Immunol

105

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Perioperative hypersensitivity reactions constitute a first-line problem for anesthesiologists and allergists, so it is advisable that hospitals have a consensus protocol for the diagnosis and management of these reactions. However, this kind of protocols is not present in many hospitals, leading to problems in treatment, the communication of incidents and subsequent etiological diagnosis. In this document we present a systematic review of the available scientific evidence and provide general guidelines for the management of acute episodes and Resumen:Las reacciones de hipersensibilidad perioperatorias constituyen un problema de primera línea para los anestesiólogos y alergólogos, por lo que es recomendable que los hospitales tengan un protocolo de consenso para el diagnóstico y el tratamiento de estas reacciones. Sin embargo, este tipo de protocolos no está presente en muchos hospitales, lo que conlleva problemas en el tratamiento, la comunicación de incidentes y el posterior diagnóstico etiológico. Este documento ha sido creado por miembros del Comité de Alergia a Medicamentos de la Sociedad Española de Alergia e Inmunología Clínica (SEAIC) en colaboración con miembros de la Sociedad Española de Anestesia (SEDAR). Se ha realizado una revisión sistemática de la evidencia científica disponible y se proporcionan pautas generales para el manejo de episodios agudos y para la derivación de pacientes con reacciones de hipersensibilidad perioperatoria a los Servicios de Alergología. Se propone un algoritmo práctico para el diagnóstico etiológico y se brindan recomendaciones para el manejo de pacientes con reacciones alérgicas perioperatorias.

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Section: Skin Testsmentioning

confidence: 99%

Practical Guidelines for Perioperative Hypersensitivity Reactions

Laguna¹,

Archilla²,

Doña³

et al. 2018

J Investig Allergol Clin Immunol

105

View full text Add to dashboard Cite

show abstract

“…Evidence has accumulated that flow cytometric analysis and quantification of in vitro activated basophils can add to the diagnosis of anaphylaxis from NMBA (64)(65)(66)(67). In these series, sensitivity and specificity of the technique is around 60 and 90% respectively.…”

Section: Neuromuscular Blocking Agentsmentioning

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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“…This sensitivity is lower (36%) when the marker CD203c is used (Sudheer et al, 2005). However, results are discordant; Kvedarine et al (Kvedariene et al, 2006) observed in 47 patients a sensitivity of 36% and a specificity of 93% performing BAT (CD63 in whole blood). On the other hand, Ebo et al (Ebo et al, 2006b) reported the sensitivity of a similar BAT technique to be 91.7% and the specificity 100% for rocuronium in a study including 14 patients with an anaphylactic reaction to drugs and with a positive skin test to rocuronium.…”

Section: Basophil Activation Test In Muscle Relaxant Allergic Reactionsmentioning

confidence: 99%

“…Relevant studies have found that BAT sensitivity and specificity for muscle relaxants varied from 36% to 92% and 93% to 100%, respectively (Sudheer et al, 2005). Most of these studies reported a high specificity and a sensitivity above 50%, reaching 91% (Abuaf et al, 1999;Kvedariene et al, 2006;Laxenaire et al, 1999;Monneret et al, 2002;Moss, 1995;Stellato et al, 1991). This sensitivity is lower (36%) when the marker CD203c is used (Sudheer et al, 2005).…”

Section: Basophil Activation Test In Muscle Relaxant Allergic Reactionsmentioning

confidence: 99%

“…On the other hand, Ebo et al (Ebo et al, 2006b) reported the sensitivity of a similar BAT technique to be 91.7% and the specificity 100% for rocuronium in a study including 14 patients with an anaphylactic reaction to drugs and with a positive skin test to rocuronium. However, the sensitivity apparently increases up to 80% when BAT is performed shortly after the clinical reaction (Kvedariene et al, 2006); this technique allows evaluation of the cross-reactivity between different muscle relaxants (Ebo et al, 2006b). Leysen et al (Leysen et al, 2011) recently reported that BAT is complementary to skin testing in the assessment of cross-reactivity between rocuronium and vecuronium.…”

Section: Basophil Activation Test In Muscle Relaxant Allergic Reactionsmentioning

confidence: 99%

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