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

Kim, Suk Yeon; Kim, Joo Hee; Jang, Young Chul; Choi, Jeong Hee; Park, Sunghoon; Hwang, Yong Il; Jang, Seung Hun; Jung, Ki Suck

doi:10.4168/aair.2016.8.6.541

Cited by 29 publications

(28 citation statements)

References 15 publications

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“…BAT was reported as useful in the diagnosis of quinolone hypersensitivity919 whereas some authors demonstrated contradictory results 14. BAT could be a useful option in the conditions that skin testing is not suitable for the drugs or for the hypersensitivity reactions like anaphylaxis 36. In addition, it is known that the usage of BAT is limited to some qualified and specialized centers 37.…”

Section: Discussionmentioning

confidence: 99%

Usefulness ofIn VivoandIn VitroDiagnostic Tests in the Diagnosis of Hypersensitivity Reactions to Quinolones and in the Evaluation of Cross-Reactivity: A Comprehensive Study Including the Latest Quinolone Gemifloxacin

Demir

Gelincik

Akdeniz

et al. 2017

Allergy Asthma Immunol Res

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PurposeReports evaluating diagnosis and cross reactivity of quinolone hypersensitivity have revealed contradictory results. Furthermore, there are no reports investigating the cross-reactivity between gemifloxacin (GFX) and the others. We aimed to detect the usefulness of diagnostic tests of hypersensitivity reactions to quinolones and to evaluate the cross reactivity between different quinolones including the latest quinolone GFX.MethodsWe studied 54 patients (mean age 42.31±10.39 years; 47 female) with 57 hypersensitivity reactions due to different quinolones and 10 nonatopic quinolone tolerable control subjects. A detailed clinical history, skin test (ST), and single-blind placebo-controlled drug provocation test (SBPCDPT), as well as basophil activation test (BAT) and lymphocyte transformation test (LTT) were performed with the culprit and alternative quinolones including ciprofloxacin (CFX), moxifloxacin (MFX), levofloxacin (LFX), ofloxacin (OFX), and GFX.ResultsThe majority (75.9%) of the patients reported immediate type reactions to various quinolones. The most common culprit drug was CFX (52.6%) and the most common reaction type was urticaria (26.3%). A quarter of the patients (24.1%) reacted to SBPCDPTs, although their STs were negative; while false ST positivity was 3.5% and ST/SBPCDPTs concordance was only 1.8%. Both BAT and LTT were not found useful in quinolone hypersensitivity. Cross-reactivity was primarily observed between LFX and OFX (50.0%), whereas it was the least between MFX and the others, and in GFX hypersensitive patients the degree of cross-reactivity to the other quinolones was 16.7%.ConclusionsThese results suggest that STs, BAT, and LTT are not supportive in the diagnosis of a hypersensitivity reaction to quinolone as well as in the prediction of cross-reactivity. Drug provocation tests (DPTs) are necessary to identify both culprit and alternative quinolones.

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Section: Discussionmentioning

confidence: 99%

Usefulness ofIn VivoandIn VitroDiagnostic Tests in the Diagnosis of Hypersensitivity Reactions to Quinolones and in the Evaluation of Cross-Reactivity: A Comprehensive Study Including the Latest Quinolone Gemifloxacin

Demir

Gelincik

Akdeniz

et al. 2017

Allergy Asthma Immunol Res

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“…However, the IDT using levodropropizine induced a positive response (A/H ratio of 3+ at 0.1 mg/mL). To confirm the diagnosis of anaphylaxis due to levodropropizine, we planned BATs instead of OPTs, according to the previously described method 4. We found a significant up-regulation of CD63 expression after stimulation with levodropropizine (Figure).…”

Section: Case Reportmentioning

confidence: 93%

Levodropropizine-Induced Anaphylaxis: Case Series and Literature Review

Song

Jang

Jung

et al. 2017

Allergy Asthma Immunol Res

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Levodropropizine is commonly used as an antitussive drug for acute and chronic cough. It is a non-opioid agent with peripheral antitussive action via the modulation of sensory neuropeptide levels in the airways. Thus, levodropropizine has a more tolerable profile than opioid antitussives. However, we experienced 3 cases of levodropropizine-induced anaphylaxis. Three patients commonly presented with generalized urticaria, dyspnea, and collapse after taking cold medication including levodropropizine. To find out the culprit drug, we performed skin tests, oral provocation tests (OPTs), and basophil activation tests (BATs). Two patients were confirmed as having levodropropizine-induced anaphylaxis by OPTs, and one of them showed positive to skin prick tests (SPTs). The other patient was confirmed by skin tests and BATs. When we analyzed pharmacovigilance data related to levodropropizine collected for 5 years, most cases (78.9%) had allergic reactions, such as rash, urticaria, angioedema, and anaphylaxis. Therefore, physicians should consider that levodropropizine can be a culprit drug, when anaphylaxis occurs after taking anti-cough or common cold medication.

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“…Additionally, during anaphylaxis, proteins such as CD63 and CD203c become newly or increasingly expressed on the surface of basophils. These can be detected by flow cytometry, which forms the basis of experimental drug‐induced basophil activation tests 51. In future, basophil activation tests may replace skin tests as the gold standard for making a definitive diagnosis of anaphylaxis, as this assay has the advantage of not being associated with the risk of inducing anaphylaxis during the test 52.…”

Section: Confirmation Of Anaphylaxis Trigger(s)mentioning

confidence: 99%

Drug‐induced anaphylaxis in the emergency room

Takazawa

Oshima

Saito

2017

Acute Medicine & Surgery

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Anaphylaxis is a life‐threatening, systemic allergic reaction that presents unique challenges for emergency care practitioners. Anaphylaxis occurs more frequently than previously believed. Therefore, proper knowledge regarding the epidemiology, mechanisms, symptoms, diagnosis, and treatment of anaphylaxis is essential. In particular, the initial treatment strategy, followed by correct diagnosis, in the emergency room is critical for preventing fatal anaphylaxis, although making a diagnosis is not easy because of the broad and often atypical presentation of anaphylaxis. To this end, the clinical criteria proposed by the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network are useful, which, together with a differential diagnosis, could enable a more accurate diagnosis. Additional in vitro tests, such as plasma histamine and tryptase measurements, are also helpful. It should be emphasized that adrenaline is the only drug recommended as first‐line therapy in all published national anaphylaxis guidelines. Most international anaphylaxis guidelines recommend injecting adrenaline by the intramuscular route in the mid‐anterolateral thigh, whereas i.v. adrenaline is an option for patients with severe hypotension or cardiac arrest unresponsive to intramuscular adrenaline and fluid resuscitation. In addition to the route of administration, choosing the appropriate dose of adrenaline is essential, because serious adverse effects can potentially occur after an overdose of adrenaline. Furthermore, to avoid future recurrence of anaphylaxis, providing adrenaline auto‐injectors and making an etiological diagnosis, including confirmation of the offending trigger, are recommended for patients at risk of anaphylaxis before their discharge from the emergency room.

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

Cited by 29 publications

References 15 publications

Usefulness ofIn VivoandIn VitroDiagnostic Tests in the Diagnosis of Hypersensitivity Reactions to Quinolones and in the Evaluation of Cross-Reactivity: A Comprehensive Study Including the Latest Quinolone Gemifloxacin

Usefulness ofIn VivoandIn VitroDiagnostic Tests in the Diagnosis of Hypersensitivity Reactions to Quinolones and in the Evaluation of Cross-Reactivity: A Comprehensive Study Including the Latest Quinolone Gemifloxacin

Levodropropizine-Induced Anaphylaxis: Case Series and Literature Review

Drug‐induced anaphylaxis in the emergency room

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