Predictive value of allergy tests for neuromuscular blocking agents: tackling an unmet need

Leysen, Julie; Uyttebroek, Astrid P.; Sabato, Vito; Bridts, Chris H.; Clerck, Luc S. De; Ebo, Didier G.

doi:10.1111/cea.12344

Cited by 63 publications

(65 citation statements)

References 25 publications

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“…Some authors have obtained promising results in reactions induced by muscle relaxants and they have been recommended for routine analysis [139]. Moreover, some authors consider that BAT to muscle relaxants are useful for diagnosis, even in patients with negative ST results, and can be used for the identification of safe alternatives [137,139,140]. However the identification of safe alternatives based on BAT only should be regarded with caution, taking into account that only small series with BAT have been reported.…”

Section: Basophil Activation Test (Bat) This Test Can Be Useful To Cmentioning

confidence: 99%

“…The recommendation is to use a muscle relaxant that gives negative intradermal STs and BAT [12,140]. Although a great cross-reactivity exists between muscle relaxants (65% if the reaction was induced by rocuronium and 29% for succinilcoline) [155] the sensitization to all of them is low [146] (grade of recommendation, C).…”

Section: Recomendations After the Allergological Studymentioning

confidence: 99%

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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: Basophil Activation Test (Bat) This Test Can Be Useful To Cmentioning

confidence: 99%

Section: Recomendations After the Allergological Studymentioning

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

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“…IgE-dependency-based theory has not been able to fully explain the high rate of anaphylactic reactions upon the first exposure as well as the high rate of cross-sensitization demonstrated by various NMBA. In addition, many rocuronium IgE positive cases have negative skin test reactivity to rocuronium [6] and some of these patients can safely receive rocuronium [7].…”

Section: Discussionmentioning

confidence: 99%

Rocuronium anaphylaxis in a 7-year-old boy during the induction of anesthesia

Morimoto

Satake

Kamitani

et al. 2018

Immunological Medicine

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We report a case of rocuronium-induced anaphylaxis in a previously healthy 7-year-old boy. The first presenting sign of anaphylaxis was bronchospasm, appearing 11 min after he received intravenous doses of rocuronium (1 mg/kg) (Eslax V R , MSD Co. Ltd., Tokyo, Japan), propofol (2 mg/kg), and cefazolin sodium (25 mg/kg). After the administration of adrenalin and ephedrine hydrochloride, bronchospasm resolved, and the vital signs became stable. Percutaneous pinning of his left humeral supracondylar fracture was performed without problems. The next day, he was successfully liberated from the ventilator support and discharged on the fifth hospital day. On the 76th postoperative day, we performed intradermal tests of rocuronium, propofol, and cefazolin. It showed that diluted rocuronium alone induced 14 mm of flare and 8 mm of wheal within 5 min, both of which disappeared within 15 min after the intradermal injection. The reaction was too quick to mention the possible contribution of rocuronium-specific IgE. His rapid reaction at the rocuronium skin test and anaphylactic reaction upon the first exposure to this drug may highlight the association of rocuronium anaphylaxis with IgE independent mast cell stimulation through mas-related G-protein coupled receptor X2 (MRGPRX2 receptor). ARTICLE HISTORY

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“…The predictive value, especially the negative predictive value of BAT, in the diagnosis of anaphylaxis to neuromuscular blocking agents is very good [69]. BAT should always only be considered after skin testing and s-IgE determination have been explored, unless there is evidence of the superiority of BAT.…”

Section: Progress In the Diagnosis And Monitoring Of Allergy By Basopmentioning

confidence: 99%

“…BAT should always only be considered after skin testing and s-IgE determination have been explored, unless there is evidence of the superiority of BAT. BAT is the only useful test during the diagnosis of rocuronium-related responses [69]. …”

Section: Progress In the Diagnosis And Monitoring Of Allergy By Basopmentioning

confidence: 99%

News in Cellular Allergology: A Review of the Human Mast Cell and Basophil Granulocyte Literature from January 2013 to May 2015

Hoffmann

2015

Int Arch Allergy Immunol

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Mast cell activation releases the mediators associated with type I allergy. As such, the study of mast cell activation is critical for understanding the allergic reaction, and for developing methods to control it. Importantly, another ligand receptor pair (compound 48/80 and MRGPRX2) that activates mast cells in addition to allergen-IgE-FcεRI has been identified. As mast cells mature in tissue from hematopoietic stem cells, their physiology and pathophysiology is difficult to study. Mast cell lines and mast cells cultured from stem cells are often studied instead of tissue mast cells. There has been some progress in the description of the mechanism of the activation of mast cells, substances limiting mast cell activation and in the catalogue of proteases that mast cells express. Basophil granulocytes express FcεRI, bind IgE and respond to allergen crosslinking in a very similar fashion to mast cells. In the recent literature, basophils were mistakenly described as antigen-presenting cells; this has convincingly been disputed in a number of subsequent publications. Their function in physiology and pathophysiology is not known, but they are frequently used to document allergic sensitisation in the basophil activation test. Significant progress has been made in documenting the relevance of basophil activation as a second-line test in allergy diagnosis. Basophil reactivity and sensitivity may reflect symptom severity and allergen threshold, and are used to document and monitor allergy. The physiology and pathophysiology of allergic effector cells remain an important area of research.

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Predictive value of allergy tests for neuromuscular blocking agents: tackling an unmet need

Cited by 63 publications

References 25 publications

Practical Guidelines for Perioperative Hypersensitivity Reactions

Practical Guidelines for Perioperative Hypersensitivity Reactions

Rocuronium anaphylaxis in a 7-year-old boy during the induction of anesthesia

News in Cellular Allergology: A Review of the Human Mast Cell and Basophil Granulocyte Literature from January 2013 to May 2015

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