Heterogeneity of Human Mast Cells and Basophils in Response to Muscle Relaxants

Stellato, Cristiana; Paulis, Amato de; Cirillo, R; Mastronardi, P; Mazzarella, B; Marone, Gianni

doi:10.1097/00000542-199106000-00016

Cited by 87 publications

(33 citation statements)

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“…With a positive history very suggestive of clinical anaphylaxis and a negative skin prick test, the picture is potentially very difficult to interpret. There is laboratory evidence that mast cells in different tissues react differently to muscle relaxants [14], suggesting that even if the skin mast cells are negative, mast cells from elsewhere might be reactive, making evaluation complex. Basophil activation tests are not directly comparable to mast cell reactivity using skin prick tests, even though both these cell types have FceR1-type receptors on their cell surface which cross-link via IgE.…”

Section: Discussionmentioning

confidence: 99%

Flow cytometric investigation of peri‐anaesthetic anaphylaxis using CD63 and CD203c

et al. 2005

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SummaryThe investigation of anaphylactic reactions in the peri-operative period is difficult. Elevation of serum tryptase levels is a good indicator of an anaphylactic event but the ability of subsequent investigations to identify the drug(s) responsible for the reaction is still potentially unreliable. The aim of this study was to examine basophil activation as an investigative tool. We performed flow cytometric analysis of the expression on the cell surface of the basophil activation markers CD63 and CD203c and measured histamine release in 21 patients who were referred with possible peri-operative anaphylaxis. The sensitivity of CD63, CD203c, basophil histamine release and skin prick for the muscle relaxants was found to be 79%, 36%, 36% and 64%, respectively; the specificity was found to be 100%. These results demonstrate the difficulty in investigating the cause of an unexpected clinical event following drug administration, but the higher sensitivity of neo-expression on the cell surface of CD63 suggests that flow cytometric analysis of its neo-expression on basophils in vitro may be a diagnostic aid.

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Section: Discussionmentioning

confidence: 99%

Flow cytometric investigation of peri‐anaesthetic anaphylaxis using CD63 and CD203c

et al. 2005

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“…A similar propensity for clinically significant histamine release has been observed for the older-generation muscle relaxants (e.g., mivacurium, tubocurarine, and atracurium) compared with newer products, for example vecuronium and cisatracurium, when administered in standard clinical doses [48,[63][64][65][66][67]. Furthermore, a drug's basic (versus acidic) character may affect mast cell activation, because positively-charged cations, for example narcotics and muscle relaxants, are believed to be involved in mast cell activation via non-receptor-mediated G-protein activation [9,11,65,66]. There are insufficient data in the literature to conclude that a particular drug's tendency to stimulate histamine release under experimental conditions is a predictor of mast cell degranulation in children with mastocytosis [1].…”

Section: Intraoperative Managementmentioning

confidence: 82%

“…Studies of codeine, meperidine, and morphine indicate significantly more histamine release in vivo than with the newer semisynthetic opioids, fentanyl, sufentanil, and remifentanil [58,59,61,62]. A similar propensity for clinically significant histamine release has been observed for the older-generation muscle relaxants (e.g., mivacurium, tubocurarine, and atracurium) compared with newer products, for example vecuronium and cisatracurium, when administered in standard clinical doses [48,[63][64][65][66][67]. Furthermore, a drug's basic (versus acidic) character may affect mast cell activation, because positively-charged cations, for example narcotics and muscle relaxants, are believed to be involved in mast cell activation via non-receptor-mediated G-protein activation [9,11,65,66].…”

Section: Intraoperative Managementmentioning

confidence: 91%

“…During the early phase of immune-mediated anaphylaxis, both serum histamine and tryptase levels increase. The serum half-life of histamine is less than 30 min and levels fall abruptly within 1 h of anaphylaxis [18,49,66]. In both IgE-like and nonimmune anaphylaxis-like incidents, tryptase, with a longer serum half life of approximately 90 min, peaks as histamine levels are declining and will not typically fall to normal levels for 4-6 h after the incident [91].…”

Section: Intraoperative Crisis Managementmentioning

confidence: 99%

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Anesthetic considerations in pediatric mastocytosis: a review

Klein

Misseldine

2013

J Anesth

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Mastocytosis is an orphan disease rarely encountered by practicing anesthesiologists. Children with mastocytosis often present for procedures or surgery requiring anesthesia. Because many of the medications commonly used in pediatric anesthesia have been reported to initiate mast cell activation, parents are often very anxious about their child's perioperative experience. Laboratory investigations of serum histamine assays associated with different anesthetic drugs have not been shown to predict mast cell degranulation in these patients. However, the pediatric literature suggests that children with disease limited to the skin rarely suffer serious side effects from anesthesia, and there are no reported fatalities. Preoperative prophylaxis is usually based on expert opinion and case reports. Detailed tables summarizing reports of anesthetic medications used for children with mastocytosis undergoing anesthesia, reported side effects, and suggested prophylaxis regimens are included in this review.

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“…To minimize degradation of PGD,, the compound was assayed with a previously described RIA (15) within 24 hours of the experiment (16). The anti-PGD, antibody is highly selective, with <1% crossreactivity with other eicosanoids (15). The rabbit anti-LTC, antiserum has been characterized and its cross-reactivity for heterologous ligand described (17).…”

Section: Drug Effects On Human Synovialmentioning

confidence: 99%

Human synovial mast cells. II. Heterogeneity of the pharmacologic effects of antiinflammatory and immunosuppressive drugs

Paulis

Ciccarelli

Marinò

et al. 1997

Arthritis & Rheumatism

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Objective. To evaluate the in vitro effects of 4 antiinflammatory and 5 immunosuppressive agents on the release of preformed and de novo‐synthesized mediators from human synovial mast cells (HSyMC) activated by immunologic and nonimmunologic stimuli. Methods. The effects of antiinflammatory and immunosuppressive agents were evaluated on the in vitro release of histamine and tryptase and the de novo synthesis of prostaglandin D2 (PGD2) and leukotriene C4 (LTC4) by HSyMC challenged with anti‐IgE and substance P. Results. Nimesulide, a sulfonanilide nonsteroidal antiinflammatory drug (NSAID) chemically unrelated to other acidic NSAIDs (such as acetylsalicylic acid [ASA], diclofenac, and piroxicam) inhibited in a concentration‐dependent manner the release of preformed (histamine and tryptase) mediators from HSyMC challenged with anti‐IgE. In contrast, diclofenac and piroxicam had little or no effect on HSyMC activated by anti‐IgE. ASA, diclofenac, piroxicam, and nimesulide caused a concentration‐dependent inhibition of IgE‐mediated PGD2 release from HSyMC. Nimesulide, but not diclofenac or piroxicam, also inhibited the de novo synthesis of LTC4 by HSyMC challenged with anti‐IgE. Nimesulide, diclofenac, and piroxicam had no effect on HSyMC activated by substance P. Cyclosporin A (CSA) inhibited histamine release from HSyMC challenged with anti‐IgE, whereas cyclosporin H (CSH) had no effect. FK‐506 also inhibited histamine release from HSyMC activated by anti‐IgE, whereas rapamycin had no effect. Neither CSA, CSH, FK‐506, nor rapamycin inhibited the release of histamine from HSyMC induced by substance P. Methotrexate had no effect on the release of mediators from these cells, whereas adenosine (R‐phenylisopropyl adenosine and 5‐N‐ethylcarboxamide adenosine) enhanced histamine release from immunologically activated HSyMC in a concentration‐dependent manner. Conclusion. Mast cells isolated from human synovia display 4 levels of pharmacologic heterogeneity with regard to 1) the inhibitory effects of 4 antiinflammatory drugs; 2) the capacity of different immunosuppressive drugs to exert antiinflammatory activity; 3) the inhibition of the release of different mediators; and 4) the capacity of antiinflammatory and immunosuppressive drugs to modulate HSyMC activated by different stimuli. This complexity of pharmacologic modulation of HSyMC in vitro might help explain the different activity of the compounds used to treat various pathophysiologic aspects of the inflammatory arthritides.

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Heterogeneity of Human Mast Cells and Basophils in Response to Muscle Relaxants

Cited by 87 publications

References 0 publications

Flow cytometric investigation of peri‐anaesthetic anaphylaxis using CD63 and CD203c

Flow cytometric investigation of peri‐anaesthetic anaphylaxis using CD63 and CD203c

Anesthetic considerations in pediatric mastocytosis: a review

Human synovial mast cells. II. Heterogeneity of the pharmacologic effects of antiinflammatory and immunosuppressive drugs

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