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The role of basophil activation test in allergic bronchopulmonary aspergillosis and Aspergillus fumigatus sensitization in cystic fibrosis patients. J Cyst Fibros 2016; 15:587-96. [DOI: 10.1016/j.jcf.2016.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/28/2016] [Accepted: 02/05/2016] [Indexed: 11/21/2022]
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Kim SY, Kim JH, Jang YS, Choi JH, Park S, Hwang YI, Jang SH, Jung KS. The Basophil Activation Test Is Safe and Useful for Confirming Drug-Induced Anaphylaxis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2016; 8:541-4. [PMID: 27582406 PMCID: PMC5011055 DOI: 10.4168/aair.2016.8.6.541] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/05/2015] [Indexed: 12/03/2022]
Abstract
The basophil activation test (BAT) has been suggested as a complementary method for diagnosing drug allergies. The aim of this study was to evaluate the clinical utility of this test in patients with drug-induced anaphylaxis. In total, 19 patients, all of whom had a history of moderate to severe anaphylaxis, were enrolled. None of the causative drugs had available in vitro tests or reliable skin tests; these drugs included, among others, first and second-generation cephalosporins, H2 blockers, and muscle relaxants. The BAT yielded positive results in 57.9% of the cases, which was similar those results of skin prick and intradermal tests (42.1% and 57.9%, respectively). When basophils were double labelled with CD63 and CD203c, both of which are basophil activation markers, the positive rate was increased from 57.9% to 73.7%. Therefore, the results of this study confirm that the BAT is a quick, reliable, and safe diagnostic tool for patients with drug-induced anaphylaxis.
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Affiliation(s)
- Suk Yeon Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Joo Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
| | - Young Sook Jang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jeong Hee Choi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Sunghoon Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Yong Il Hwang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Ki Suck Jung
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Mukai K, Gaudenzio N, Gupta S, Vivanco N, Bendall SC, Maecker HT, Chinthrajah RS, Tsai M, Nadeau KC, Galli SJ. Assessing basophil activation by using flow cytometry and mass cytometry in blood stored 24 hours before analysis. J Allergy Clin Immunol 2016; 139:889-899.e11. [PMID: 27527263 DOI: 10.1016/j.jaci.2016.04.060] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/24/2016] [Accepted: 04/19/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Basophil activation tests (BATs) have promise for research and for clinical monitoring of patients with allergies. However, BAT protocols vary in blood anticoagulant used and temperature and time of storage before testing, complicating comparisons of results from various studies. OBJECTIVE We attempted to establish a BAT protocol that would permit analysis of blood within 24 hours of obtaining the sample. METHODS Blood from 46 healthy donors and 120 patients with peanut allergy was collected into EDTA or heparin tubes, and samples were stored at 4°C or room temperature for 4 or 24 hours before performing BATs. RESULTS Stimulation with anti-IgE or IL-3 resulted in strong upregulation of basophil CD203c in samples collected in EDTA or heparin, stored at 4°C, and analyzed 24 hours after sample collection. However, a CD63hi population of basophils was not observed in any conditions in EDTA-treated samples unless exogenous calcium/magnesium was added at the time of anti-IgE stimulation. By contrast, blood samples collected in heparin tubes were adequate for quantification of upregulation of basophil CD203c and identification of a population of CD63hi basophils, irrespective of whether the specimens were analyzed by means of conventional flow cytometry or cytometry by time-of-flight mass spectrometry, and such tests could be performed after blood was stored for 24 hours at 4°C. CONCLUSION BATs to measure upregulation of basophil CD203c and induction of a CD63hi basophil population can be conducted with blood obtained in heparin tubes and stored at 4°C for 24 hours.
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Affiliation(s)
- Kaori Mukai
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Nicolas Gaudenzio
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Sheena Gupta
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, Calif
| | - Nora Vivanco
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Stanford Blood Center, Palo Alto, Calif
| | - Sean C Bendall
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Stanford Blood Center, Palo Alto, Calif
| | - Holden T Maecker
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, Calif; Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, Calif
| | - Rebecca S Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Mindy Tsai
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Stephen J Galli
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif; Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, Calif.
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Tacquard C, Laroche D, Stenger R, Mariotte D, Uring-Lambert B, De Blay F, Malinovsky JM, Mertes PM. Diagnostic procedure after an immediate hypersensitivity reaction in the operating room. Presse Med 2016; 45:784-90. [PMID: 27374263 DOI: 10.1016/j.lpm.2016.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The diagnosis of a perioperative allergic reaction is based on clinical features associated with a suggestive timeline, the exclusion of other diagnoses, elevated concentrations of degranulation markers (histamine, tryptase), and positive allergy assessments (skin tests, specific IgE). After initiating appropriate treatment, the anesthesiologist should take blood samples to measure histamine and tryptase concentrations just after the reaction and repeat them 1-2hours later to validate the diagnosis of immediate hypersensitivity. A delayed measurement of basal tryptase is useful to rule out mastocytosis and to interpret moderate tryptase levels. The anesthesiologist must inform the patient of the reaction to obtain adhesion and consent to subsequent investigations and must record the timing of the reaction and of the blood sampling, the possible causal agents, and the treatment administered. These data must be shared with the laboratory and the allergist. An adverse drug reaction report must be filed. The gold standard for allergy assessment is skin testing. These tests should be done in an appropriate facility, with experienced staff and in compliance with current guidelines. Specific IgE assays and cellular assays can help when clinical features and skin tests are discordant. Provocation tests are sometimes required. After allergy assessment, the safest protocol for subsequent anesthesia is determined in collaboration with the anesthesiologist. The patient must be informed and carry an allergy alert card.
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Affiliation(s)
- Charles Tacquard
- Hôpitaux universitaires de Strasbourg, département d'anesthésie-réanimation, 67000 Strasbourg, France.
| | | | - Rodolphe Stenger
- Hôpitaux universitaires de Strasbourg, université de Strasbourg, pôle de pathologie thoracique, fédération de médecine translationnelle, 67000 Strasbourg, France
| | | | - Béatrice Uring-Lambert
- Hôpitaux universitaires de Strasbourg, laboratoire central d'immunologie, 67000 Strasbourg, France
| | - Frédéric De Blay
- Hôpitaux universitaires de Strasbourg, université de Strasbourg, pôle de pathologie thoracique, fédération de médecine translationnelle, 67000 Strasbourg, France
| | - Jean-Marc Malinovsky
- CHU de Reims, hôpital Maison-Blanche, département d'anesthésie-réanimation, 51100 Reims, France
| | - Paul Michel Mertes
- Hôpitaux universitaires de Strasbourg, département d'anesthésie-réanimation, 67000 Strasbourg, France
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Santos AF, Bécares N, Stephens A, Turcanu V, Lack G. The expression of CD123 can decrease with basophil activation: implications for the gating strategy of the basophil activation test. Clin Transl Allergy 2016; 6:11. [PMID: 27042292 PMCID: PMC4818434 DOI: 10.1186/s13601-016-0100-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/01/2016] [Indexed: 12/17/2022] Open
Abstract
Background
Basophil activation test (BAT) reproduces IgE-mediated allergic reactions in vitro and has been used as a diagnostic test. Different markers can be used to identify basophils in whole blood and have implications for the outcome of the test. We aimed to assess changes in the expression of CD123 and HLA-DR following basophil activation and to select the best gating strategy for BAT using these markers. Methods BAT was performed in whole blood from 116 children. Peanut extract, anti-IgE, anti-FcεRI or formyl-methionyl-leucyl-phenylalanin (fMLP) was used for stimulation. Surface expression of CD123, HLA-DR, CD63 and CD203c was evaluated by flow cytometry. Results In some cases, gating on CD123+/HLA-DR− led to the loss-to-analysis of basophils in conditions where basophils were activated. Adding CD203c as an identification marker restored the cell number. Basophils remained HLA-DR-negative with activation. CD123 expression decreased following stimulation with fMLP (n = 116, p < 0.001), anti-IgE (n = 104, p < 0.001) and peanut (n = 42, p < 0.001). The decrease in the mean fluorescence intensity of CD123 correlated with the up-regulation of basophil activation markers, CD63 (rs = −0.31, p < 0.001) and CD203c (rs = −0.35, p < 0.001). BAT to peanut gating basophils on CD203c+/CD123+/HLA-DR− reduced the false-negatives (1 vs. 5 %) and showed a higher diagnostic accuracy compared to using CD123+/HLA-DR− (97 vs. 91 %). CD203c+ appeared as an alternative gating strategy allowing two-colour BAT. Conclusions
Basophils of a subset of patients down-regulate CD123 with activation. The use of CD203c before gating on CD123+/HLA-DR− cells or in isolation ensures the identification of the entire basophil population and accurate assessment of basophil activation, with important diagnostic implications.
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Affiliation(s)
- Alexandra F Santos
- Division of Asthma, Allergy and Lung Biology, Department of Pediatric Allergy, St Thomas' Hospital, King's College London, 2nd Floor, Stairwell B, South Wing, Westminster Bridge Road, London, SE1 7EH UK ; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK ; Immunoallergology Department, Coimbra University Hospital, Coimbra, Portugal ; Gulbenkian Programme for Advanced Medical Education, Lisbon, Portugal
| | - Natalia Bécares
- Division of Asthma, Allergy and Lung Biology, Department of Pediatric Allergy, St Thomas' Hospital, King's College London, 2nd Floor, Stairwell B, South Wing, Westminster Bridge Road, London, SE1 7EH UK ; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Alick Stephens
- Division of Asthma, Allergy and Lung Biology, Department of Pediatric Allergy, St Thomas' Hospital, King's College London, 2nd Floor, Stairwell B, South Wing, Westminster Bridge Road, London, SE1 7EH UK ; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Victor Turcanu
- Division of Asthma, Allergy and Lung Biology, Department of Pediatric Allergy, St Thomas' Hospital, King's College London, 2nd Floor, Stairwell B, South Wing, Westminster Bridge Road, London, SE1 7EH UK ; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Gideon Lack
- Division of Asthma, Allergy and Lung Biology, Department of Pediatric Allergy, St Thomas' Hospital, King's College London, 2nd Floor, Stairwell B, South Wing, Westminster Bridge Road, London, SE1 7EH UK ; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
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Kumagai T, Yamaguchi N, Hirai H, Kojima S, Kodani Y, Hashiguchi A, Haida M, Nakamura M. Loxoprofen sodium induces the production of complement C5a in human serum. Int Immunopharmacol 2016; 33:55-62. [DOI: 10.1016/j.intimp.2016.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/08/2016] [Accepted: 01/26/2016] [Indexed: 12/27/2022]
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Faber MA, Sabato V, Decuyper II, Van Gasse AL, Hagendorens MM, Bridts CH, De Clerck LS, Ebo DG. Basophil Activation Test in IgE-Mediated Food Allergy: Should We Follow the Flow? CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0081-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Santos AF, Lack G. Basophil activation test: food challenge in a test tube or specialist research tool? Clin Transl Allergy 2016; 6:10. [PMID: 26981234 PMCID: PMC4791855 DOI: 10.1186/s13601-016-0098-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/29/2016] [Indexed: 12/17/2022] Open
Abstract
Oral food challenge (OFC) is the gold-standard to diagnose food allergy; however, it is a labour and resource-intensive procedure with the risk of causing an acute allergic reaction, which is potentially severe. Therefore, OFC are reserved for cases where the clinical history and the results of skin prick test and/or specific IgE do not confirm or exclude the diagnosis of food allergy. This is a significant proportion of patients seen in Allergy clinics and results in a high demand for OFC. The basophil activation test (BAT) has emerged as a new diagnostic test for food allergy. With high diagnostic accuracy, it can be particularly helpful in the cases where skin prick test and specific IgE are equivocal and may allow reducing the need for OFC. BAT has high specificity, which confers a high degree of certainty in confirming the diagnosis of food allergy and allows deferring the performance of OFC in patients with a positive BAT. The diagnostic utility of BAT is allergen-specific and needs to be validated for different allergens and in specific patient populations. Standardisation of the laboratory methodology and of the data analyses would help to enable a wider clinical application of BAT.
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Affiliation(s)
- Alexandra F Santos
- Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, King's College London, London, UK ; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Gideon Lack
- Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, King's College London, London, UK ; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
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Teodorowicz M, Terlouw RJ, Jansen A, Savelkoul HFJ, Ruinemans-Koerts J. Immunological Characterization of Dutch Sesame Seed-Allergic Patients. Int Arch Allergy Immunol 2016; 169:13-22. [PMID: 26954556 DOI: 10.1159/000443641] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/22/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sesame seed is an allergen of growing importance worldwide. However, knowledge of the clinically relevant sesame allergen and its cross-reactivity with homologous allergens is limited. The aim of this study was the immunological characterization of Dutch sesame seed-allergic patients and evaluation of cross-reactivity between sesame seed, tree nut and pollen allergens using different sources of allergen extracts. METHODS Six patients with a medical history of sesame seed allergy were included, i.e. 5 with an anaphylactic reaction and 1 with an oral allergy syndrome (OAS). The immunological background of the sesame seed and tree nut IgE sensitization was characterized with Western blotting and a basophil activation test (BAT). The major sesame allergen was identified by nanoLC-MS/MS. Cross-reactivity was measured using an immuno-inhibition assay with the Phadia ImmunoCAP system. RESULTS Oleosin was identified as the major allergen for the 5 patients with an anaphylactic reaction to sesame seed, but no cross-reactivity between sesame and tree nut proteins was observed. For the patient with OAS, IgE specific to oleosin was not detected but cross-reactivity between sesame seed and tree nut proteins was observed. The BAT and ImmunoCAP inhibition test added value to the clinical and immunological characterization of sesame seed-sensitized patients, distinguishing relevant and non-relevant sensitizations. CONCLUSIONS Our immunological approach enabled us to fully characterize the sensitization pattern of 6 sesame seed-allergic patients. The different protein composition of commercially available allergen extracts influences the outcomes of the immunological assays and thus also the diagnosis to a large extent.
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Affiliation(s)
- Malgorzata Teodorowicz
- Department of Cell Biology and Immunology, Wageningen University, Wageningen, The Netherlands
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Allergy Testing and Drug Screening on an ITO-Coated Lab-on-a-Disc. MICROMACHINES 2016; 7:mi7030038. [PMID: 30407411 PMCID: PMC6189934 DOI: 10.3390/mi7030038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/15/2016] [Accepted: 02/24/2016] [Indexed: 11/22/2022]
Abstract
A lab-on-a-disc (LOAD) is a centrifugal microfluidic set-up based on centrifugal force without using micro-pumps to drive reagents and cells to various chambers through channels and valves for reactions. A LOAD coated with conductive transparent indium tin oxide (ITO) for thermal control was developed to screen allergy-blocking agents. When the acridine orange (AO)-loaded KU-812 human basophilic cells were activated in the LOAD by stimuli, AO trapped in the cytoplasmic granules was released externally as an allergic mediator mimetic to report degranulation. This response was monitored by fluorescence when the released AO in supernatant had been transferred, with a higher spinning speed, from the reaction chamber to detection chamber in the LOAD where AO reacted with exogenous DNA. We report here the principles of the system and an improved LOAD set-up with the ITO-coated glass resistive microheater to run assays at 37 °C. By using this platform, we demonstrate here for the first time that triptolide, an active ingredient from the Chinese medicine herb Tripterygium wilfordii Hook f., was able to suppress the fMLP-mediated degranulation in basophils. This serves as an example how LOADs can be used to screen agents to alleviate symptoms of allergy.
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Pikuła M, Zieliński M, Specjalski K, Barańska-Rybak W, Dawgul M, Langa P, Jassem E, Kamysz W, Trzonkowski P. In VitroEvaluation of the Allergic Potential of Antibacterial Peptides: Camel and Citropin. Chem Biol Drug Des 2015; 87:562-8. [DOI: 10.1111/cbdd.12688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Michał Pikuła
- Department of Clinical Immunology and Transplantology; Medical University of Gdańsk; Debinki 7 80-211 Gdańsk Poland
| | - Maciej Zieliński
- Department of Clinical Immunology and Transplantology; Medical University of Gdańsk; Debinki 7 80-211 Gdańsk Poland
| | - Krzysztof Specjalski
- Department of Allergology; Medical University of Gdańsk; Debinki 7 80-211 Gdańsk Poland
| | - Wioletta Barańska-Rybak
- Department of Dermatology, Venereology and Allergology; Medical University of Gdańsk; Debinki 7 80-211 Gdańsk Poland
| | - Małgorzata Dawgul
- Department of Inorganic Chemistry; Medical University of Gdańsk; Al. Hallera 107 80-416 Gdańsk Poland
| | - Paulina Langa
- Department of Clinical Immunology and Transplantology; Medical University of Gdańsk; Debinki 7 80-211 Gdańsk Poland
| | - Ewa Jassem
- Department of Allergology; Medical University of Gdańsk; Debinki 7 80-211 Gdańsk Poland
| | - Wojciech Kamysz
- Department of Inorganic Chemistry; Medical University of Gdańsk; Al. Hallera 107 80-416 Gdańsk Poland
- R&D Laboratory; Lipopharm.pl; Koscielna 16A 83-210 Zblewo Poland
| | - Piotr Trzonkowski
- Department of Clinical Immunology and Transplantology; Medical University of Gdańsk; Debinki 7 80-211 Gdańsk Poland
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Mangodt EA, Van Gasse AL, Decuyper I, Uyttebroek A, Faber MA, Sabato V, Bridts CH, Hagendorens MM, Ebo DG. In vitro Diagnosis of Immediate Drug Hypersensitivity: Should We Go with the Flow. Int Arch Allergy Immunol 2015; 168:3-12. [PMID: 26524156 DOI: 10.1159/000440663] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diagnosis of immediate drug hypersensitivity reactions (IDHRs) is based upon history taking, skin prick or intradermal tests and quantification of specific immunoglobulin E (IgE) antibodies. Unfortunately, this is often insufficient to correctly identify patients with IgE-mediated IDHRs and is impossible in the case of non-IgE-mediated IDHRs. Drug provocation tests (DPT) are considered the 'gold standard' diagnostic but are not always possible, for ethical and practical reasons. Therefore, the validation of new cellular tests such as basophil activation testing (BAT) was necessary. This review focuses on the applications of BAT in IDHRs. METHODS A literature search was conducted, using the words basophil, flow cytometry, immediate drug allergy and drugs; this was complemented by the authors' own expertise. RESULTS BAT/HistaFlow® is a useful diagnostic tool in IDHRs, mainly used to diagnose allergy to neuromuscular blocking agents (NMBAs), antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs) and iodinated radiocontrast media. Its sensitivity varies between 50 and 60%, and specificity attains 80%, except for with quinolones and NSAIDs. CONCLUSIONS The diagnostic utility of BAT (and to lesser extent HistaFlow) has been demonstrated and is mostly applied in IDHRs. However, larger-scale collaborative studies are necessary to optimize test protocols and validate the entry of BAT as a diagnostic instrument in drug allergy.
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Affiliation(s)
- Evelyne A Mangodt
- Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
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IgE-mediated 15-hydroxyeicosatetraenoic acid (15-HETE) generation by peripheral blood leukocytes: its association with basophil activation. Postepy Dermatol Alergol 2015; 32:262-7. [PMID: 26366149 PMCID: PMC4565836 DOI: 10.5114/pdia.2015.52741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/14/2015] [Accepted: 02/28/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Allergen-induced basophil activation has been associated with the release of several mediators and with an increased expression of CD203c molecules on basophils. AIM To assess the influence of specific allergens on the generation of 15-hydroxyeicosatetraenoic (15-HETE) from peripheral blood leukocytes in relation to basophil activation, on the basis of CD203c molecule expression and histamine release. MATERIAL AND METHODS The study included 15 patients with clinical symptoms of birch pollen allergy confirmed by a positive skin prick test with the birch allergen, and 6 healthy controls. Leukocytes isolated from peripheral blood were incubated with 3 concentrations of the birch pollen allergen (Bet v 1), anti-IgE or with ionophore A23187. RESULTS In vitro challenge of leukocytes from allergic patients with 1 ng/ml of allergen induced a significant increase in 15-HETE generation. An increase above 30% was observed in almost half the allergic patients, with mean values ranging from 40% to 46%, but not in healthy controls. Anti-IgE antibodies increased 15-HETE generation in 5 patients (termed IgE+), and the allergen induced a significant increase in 15-HETE in all patients who reacted to anti-IgE. The mean CD203c expression on basophils of the allergic patients increased after allergen challenge, but a significant increase (> 30%) was observed only in patients who demonstrated an increased expression after anti-IgE exposure. A significant correlation was seen between 15-HETE generation and histamine release induced by the highest concentration of the allergen (r = 0.95; p < 0.01). CONCLUSIONS Allergen-induced, IgE-mediated activation of basophils is associated with a significant increase in 15-HETE generation.
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Pignatti P, Yacoub MR, Testoni C, Pala G, Corsetti M, Colombo G, Meriggi A, Moscato G. Evaluation of basophil activation test in suspected food hypersensitivity. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 92:279-285. [DOI: 10.1002/cyto.b.21264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/26/2015] [Accepted: 06/16/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Patrizia Pignatti
- Allergy and Immunology Unit; Fondazione Salvatore Maugeri, IRCCS; Pavia, Italy
| | - Mona-Rita Yacoub
- Internal Medicine and Clinical Immunology Unit; San Raffaele Hospital, IRCCS; Milan Italy
| | - Claudia Testoni
- Allergy and Immunology Unit; Fondazione Salvatore Maugeri, IRCCS; Pavia, Italy
| | - Gianni Pala
- Occupational Physician's Division, Local Health Authority of Sassari; Sassari Italy
| | - Maura Corsetti
- Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Disorders (TARGID); University of Leuven; Leuven Belgium
| | - Giselda Colombo
- Internal Medicine and Clinical Immunology Unit; San Raffaele Hospital, IRCCS; Milan Italy
| | - Antonio Meriggi
- Allergy and Immunology Unit; Fondazione Salvatore Maugeri, IRCCS; Pavia, Italy
| | - Gianna Moscato
- Allergy and Immunology Unit; Fondazione Salvatore Maugeri, IRCCS; Pavia, Italy
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Iwamoto H, Matsubara T, Nakazato Y, Namba K, Takeda Y. Decreased expression of CD200R3 on mouse basophils as a novel marker for IgG1-mediated anaphylaxis. IMMUNITY INFLAMMATION AND DISEASE 2015; 3:280-8. [PMID: 26417442 PMCID: PMC4578526 DOI: 10.1002/iid3.67] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/29/2015] [Accepted: 05/03/2015] [Indexed: 02/05/2023]
Abstract
IgE-mediated mast cell activation is the trigger of anaphylaxis in humans, whereas it is known that not only IgE but also IgG can induce anaphylaxis in mice. In our preliminary experiments, the expression of a murine basophil identification marker, CD200R3, on antigen-sensitized basophils decreased following specific antigen challenge. Interestingly, this decrease did not always correspond with increased expression of the IgE-mediated basophil activation marker CD200R1. Since IgG as well as IgE plays a role in mouse anaphylaxis, we hypothesized that the observed decrease in CD200R3 on basophils was caused by IgG-mediated cell activation. We attempted to establish whether CD200R3 is a marker of IgG-mediated basophil activation and if its expression is correlated with anaphylaxis in a mouse model. Mouse basophils were stimulated via Fc∊Rs and/or FcγRs, and levels of CD200R1 and CD200R3 were analyzed by flow cytometry. Basophils derived from naive mice were challenged with a natural antigen, β-lactoglobulin, after passive sensitization with anti-β-LG serum or IgG/IgG subclass-depleted antiserum. Systemic anaphylaxis was induced by i.v. injection of anti-FcγRIII/II monoclonal antibody, and CD200R3 expression on peripheral basophils was assessed. Stimulation via Fc∊Rs induced a significant increase in CD200R1 expression but had only a small effect on that of CD200R3. However, anti-FcγRIII/II stimulation reduced CD200R3 expression markedly. In passive sensitization experiments, down-regulation of CD200R3 induced by antigen challenge was strongly negated by the depletion of IgG or IgG1 from antiserum. Intravenous injection of anti-FcγRIII/II induced CD200R3 down-regulation on peripheral basophils, together with a drop in rectal temperature. Lowered CD200R3 expression on basophils is induced by IgG-mediated stimulation via FcγRs. Use of CD200R1 and CD200R3 as activation markers enables the evaluation of murine basophil activation mediated by IgE and IgG, respectively.
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Affiliation(s)
- Hiroshi Iwamoto
- Nutritional Science Institute, Morinaga Milk Industry Co., Ltd. Zama, Kanagawa, 252-8583, Japan
| | - Takeshi Matsubara
- Nutritional Science Institute, Morinaga Milk Industry Co., Ltd. Zama, Kanagawa, 252-8583, Japan
| | - Yuki Nakazato
- Nutritional Science Institute, Morinaga Milk Industry Co., Ltd. Zama, Kanagawa, 252-8583, Japan
| | - Kazuyoshi Namba
- Nutritional Science Institute, Morinaga Milk Industry Co., Ltd. Zama, Kanagawa, 252-8583, Japan
| | - Yasuhiro Takeda
- Nutritional Science Institute, Morinaga Milk Industry Co., Ltd. Zama, Kanagawa, 252-8583, Japan
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Cop N, Uyttebroek AP, Sabato V, Bridts CH, De Clerck LS, Ebo DG. Flow cytometric analysis of drug-Induced basophil histamine release. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 90:285-8. [DOI: 10.1002/cyto.b.21226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 12/16/2014] [Accepted: 01/14/2015] [Indexed: 11/10/2022]
Affiliation(s)
- N. Cop
- Department of Immunology; Allergology; Rheumatology; Faculty of Medicine and Health Science; University of Antwerp, Antwerp University Hospital; Antwerpen 2610 Belgium
| | - A. P. Uyttebroek
- Department of Immunology; Allergology; Rheumatology; Faculty of Medicine and Health Science; University of Antwerp, Antwerp University Hospital; Antwerpen 2610 Belgium
| | - V. Sabato
- Department of Immunology; Allergology; Rheumatology; Faculty of Medicine and Health Science; University of Antwerp, Antwerp University Hospital; Antwerpen 2610 Belgium
| | - C. H. Bridts
- Department of Immunology; Allergology; Rheumatology; Faculty of Medicine and Health Science; University of Antwerp, Antwerp University Hospital; Antwerpen 2610 Belgium
| | - L. S. De Clerck
- Department of Immunology; Allergology; Rheumatology; Faculty of Medicine and Health Science; University of Antwerp, Antwerp University Hospital; Antwerpen 2610 Belgium
| | - D. G. Ebo
- Department of Immunology; Allergology; Rheumatology; Faculty of Medicine and Health Science; University of Antwerp, Antwerp University Hospital; Antwerpen 2610 Belgium
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Glaumann S, Nilsson C, Johansson SGO, Asarnoj A, Wickman M, Borres MP, Nopp A. Evaluation of basophil allergen threshold sensitivity (CD-sens) to peanut and Ara h 8 in children IgE-sensitized to Ara h 8. Clin Mol Allergy 2015; 13:5. [PMID: 25878561 PMCID: PMC4397898 DOI: 10.1186/s12948-014-0007-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/15/2014] [Indexed: 12/04/2022] Open
Abstract
Background Diagnosing peanut allergy properly is important and can be achieved by combining clinical history with various diagnostic methods such as IgE-antibody (IgE-ab) measurements, skin-prick test, basophil allergen threshold sensitivity (CD-sens) and food challenge. We aimed to evaluate CD-sens to peanut, Ara h 8 and Gly m 4 in relation to an oral peanut challenge in children IgE-sensitized to birch, peanut and Ara h 8 avoiding peanuts. Methods Twenty children IgE-sensitized to birch pollen and Ara h 8, but not to Ara h 1, Ara h 2 or Ara h 3 were challenged orally with roasted peanuts. Blood samples were drawn for IgE-ab and CD-sens analysis. To measure CD-sens, basophils were stimulated in vitro with decreasing doses of allergens until threshold sensitivity was reached. Results All children passed challenge without objective symptoms, but mild oral allergy syndrome (OAS) symptoms were reported in 6/20 children. Nineteen of twenty children were negative in CD-sens to peanut but 17/20 were positive to rAra h 8. Eleven of twenty children were positive in CD-sens to rGly m 4. Conclusion Positive CD-sens to rAra h 8 show that the Ara h 8 IgE-ab sensitized basophils can be activated by a rAra h 8 allergen and initiate an allergic inflammation despite a negative challenge. Hence, children sensitized to Ara h 8 but not to peanut storage proteins may be at risk for systemic allergic reaction when eating larger amounts of peanuts but most likely don’t have to fear smaller amounts. Electronic supplementary material The online version of this article (doi:10.1186/s12948-014-0007-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susanne Glaumann
- Department of Clinical Science and Education, Södersjukhuset, Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden ; Sachs' Children and Youth Hospital, Södersjukhuset, 118 83 Stockholm, Sweden
| | - Caroline Nilsson
- Department of Clinical Science and Education, Södersjukhuset, Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden ; Sachs' Children and Youth Hospital, Södersjukhuset, 118 83 Stockholm, Sweden
| | - S G O Johansson
- Department of Medicine, Clinical Immunology and Allergy Unit, Karolinska Institutet and Hospital, Stockholm, Sweden
| | - Anna Asarnoj
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ; Department of Women's and Children's Health, Karolinska Institutet at Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Magnus Wickman
- Sachs' Children and Youth Hospital, Södersjukhuset, 118 83 Stockholm, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus P Borres
- Thermo Fisher Scientific, Uppsala, Sweden ; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Nopp
- Department of Medicine, Clinical Immunology and Allergy Unit, Karolinska Institutet and Hospital, Stockholm, Sweden
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Leysen J, Uyttebroek A, Sabato V, Bridts CH, De Clerck LS, Ebo DG. Predictive value of allergy tests for neuromuscular blocking agents: tackling an unmet need. Clin Exp Allergy 2015; 44:1069-75. [PMID: 24848972 DOI: 10.1111/cea.12344] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/08/2014] [Accepted: 05/13/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neuromuscular blocking agents (NMBAs) are a predominant cause of perioperative anaphylaxis in Europe. Diagnosis of NMBA allergy relies upon the careful review of the anaesthetic report complemented with skin tests. Additional diagnostic tests are quantification of specific IgE antibodies (sIgE) and basophil activation test (BAT). However, data on the predictive value of the skin tests, the BAT and the sIgE assays (drug-specific and substituted ammonium structures) are limited or not available, mainly because such exploration requires dangerous NMBA provocation tests. METHODS In this study, the predictive value of skin test, BAT and measurement of sIgE to substituted ammonium structures is gathered from a review of anaesthetic records of subsequent surgical procedures with NMBA administration and/or occurrence of perioperative incidents. RESULTS We investigated a series of 272 patients with perioperative anaphylaxis, of whom 100 had undergone second general anaesthesia. Negative skin test and negative BAT assisted the selection of alternative NMBA, which were well tolerated in all cases. Five patients with a positive sIgE to rocuronium but with negative skin testing and BAT safely received rocuronium during second anaesthesia. Twelve patients with sIgE reactivity to morphine, but negative skin test and BAT to benzylisoquinolines, tolerated administration of cisatracurium or atracurium. Alternatively, benzylisoquinoline allergy went undetected in the morphine solid-phase assay. CONCLUSIONS Skin test and BAT have an excellent negative predictive value in our series. The uneventful re-exposure of rocuronium in patients with an isolated positive sIgE result to rocuronium calls into question the predictive value of this assay and suggests sIgE serology to be less clinically predictive than the functional investigations relying upon activation of mast cells or basophils. The presence of a positive sIgE to substituted ammonium structures such as morphine does not preclude further use of benzylisoquinolines.
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Affiliation(s)
- J Leysen
- Faculty of Medicine and Health Science, Department of Immunology - Allergology - Rheumatology, University of Antwerp, Antwerp University Hospital, Antwerpen, Belgium
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Eberlein B, Hann R, Eyerich S, Pennino D, Ring J, Schmidt-Weber CB, Buters J. Optimizing of the basophil activation test: Comparison of different basophil identification markers. CYTOMETRY PART B-CLINICAL CYTOMETRY 2014; 88:183-9. [PMID: 25399741 DOI: 10.1002/cyto.b.21203] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 10/25/2014] [Accepted: 11/04/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Flowcytometric identification of basophils is a prerequisite for measuring activation of basophils with IgE-dependent or IgE-independent stimuli. Aim of this study was to compare different marker combinations in a simultaneous multicolor flowcytometric measurement. METHODS Ten patients with a grass pollen allergy and three controls were included in the study. Basophilic cells were gated by using anti-CCR3, anti-IgE, anti-CRTH2, anti-CD203c, and anti-CD3. Cells were activated by a monoclonal anti-FcεRI antibody, N-formyl-methionyl-leucyl-phenylalanine (fMLP), and the allergen extract Phleum pratense. The activation marker anti-CD63 was used. RESULTS The highest relative number of basophils was found with anti-CCR3+ cells, anti-IgE+ and anti-IgE+ /anti-CD203c+ cells, the lowest with CRTH2+/CD203c+/CD3- cells. A very good and good concordance of CCR3+ cells was seen with CCR3+/CD3- cells and CRTH2+/CD203c+/CD3- cells in all experiments. The contamination of the CCR3+ population with CD3+ cells and the contamination of the IgE+-population with CCR3- cells and CD203- cells were the lowest compared to all other marker combinations. CONCLUSIONS As the highest relative number of basophils was identified by anti-CCR3 followed by the anti-IgE and anti-IgE/antiCD203c positive population in most cases, these markers can generally be recommended for identification of basophils. If a basophil population with very high purity is needed, anti-IgE should be chosen.
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Affiliation(s)
- Bernadette Eberlein
- Department of Dermatology and Allergy Biederstein, Technische Universität München, Germany, Munich, Germany
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Uyttebroek AP, Sabato V, Leysen J, Bridts CH, De Clerck LS, Ebo DG. Flowcytometric diagnosis of atracurium-induced anaphylaxis. Allergy 2014; 69:1324-32. [PMID: 24961660 DOI: 10.1111/all.12468] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Allergy to atracurium is a rare condition with serious consequences of diagnostic error. However, correct diagnosis is not always straightforward. The aim of this study is to assess the utility of the basophil activation test (BAT) in atracurium sensitization and to investigate its role in identifying cross-reactivity between muscle relaxants. METHODS For validation, eight patients with perioperative anaphylaxis to atracurium and seven individuals experiencing perioperative anaphylaxis but not exposed to neuromuscular blocking agents (NMBA) were included. Furthermore, five other patient groups were included in the study, and all individuals exposed to different NMBA, either sensitized or not to the drug. Basophil activation with atracurium was analysed flow cytometrically. RESULTS ROC analyses between eight atracurium-sensitized patients and seven nonexposed controls allowed identification of 5% as the decision threshold for BAT positivity. For this cutoff, the BAT attained a sensitivity of 63%, specificity of 100%, positive predictive value of 100% and negative predictive value of 70%. Of the atracurium-exposed individuals with a negative atracurium skin test (ST), two individuals had a clear positive BAT. BAT atracurium was positive in one cisatracurium-sensitized patient and negative in all cisatracurium-exposed patients with a negative ST to cisatracurium. All rocuronium- and suxamethonium-sensitized patients displayed a negative BAT with atracurium. CONCLUSIONS The BAT proves to be a useful diagnostic for atracurium-induced anaphylaxis and may be complementary to STs. The technique enables quick and simultaneous testing of potentially crossreactive NMBA and the identification of safe alternatives for future surgery.
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Affiliation(s)
- A. P. Uyttebroek
- Department of Immunology, Allergology, Rheumatology; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Department of Immunology, Allergology, Rheumatology; Antwerp University Hospital; Antwerp Belgium
| | - V. Sabato
- Department of Immunology, Allergology, Rheumatology; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Department of Immunology, Allergology, Rheumatology; Antwerp University Hospital; Antwerp Belgium
| | - J. Leysen
- Department of Immunology, Allergology, Rheumatology; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Department of Immunology, Allergology, Rheumatology; Antwerp University Hospital; Antwerp Belgium
| | - C. H. Bridts
- Department of Immunology, Allergology, Rheumatology; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Department of Immunology, Allergology, Rheumatology; Antwerp University Hospital; Antwerp Belgium
| | - L. S. De Clerck
- Department of Immunology, Allergology, Rheumatology; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Department of Immunology, Allergology, Rheumatology; Antwerp University Hospital; Antwerp Belgium
| | - D. G. Ebo
- Department of Immunology, Allergology, Rheumatology; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Department of Immunology, Allergology, Rheumatology; Antwerp University Hospital; Antwerp Belgium
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Uyttebroek AP, Sabato V, Faber MA, Cop N, Bridts CH, Lapeere H, De Clerck LS, Ebo DG. Basophil activation tests: time for a reconsideration. Expert Rev Clin Immunol 2014; 10:1325-35. [DOI: 10.1586/1744666x.2014.959498] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Local and General Anesthetics Immediate Hypersensitivity Reactions. Immunol Allergy Clin North Am 2014; 34:525-46, viii. [DOI: 10.1016/j.iac.2014.03.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Santos AF, Douiri A, Bécares N, Wu SY, Stephens A, Radulovic S, Chan SMH, Fox AT, Du Toit G, Turcanu V, Lack G. Basophil activation test discriminates between allergy and tolerance in peanut-sensitized children. J Allergy Clin Immunol 2014; 134:645-52. [PMID: 25065721 PMCID: PMC4164910 DOI: 10.1016/j.jaci.2014.04.039] [Citation(s) in RCA: 200] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/17/2014] [Accepted: 04/18/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Most of the peanut-sensitized children do not have clinical peanut allergy. In equivocal cases, oral food challenges (OFCs) are required. However, OFCs are laborious and not without risk; thus, a test that could accurately diagnose peanut allergy and reduce the need for OFCs is desirable. OBJECTIVE To assess the performance of basophil activation test (BAT) as a diagnostic marker for peanut allergy. METHODS Peanut-allergic (n = 43), peanut-sensitized but tolerant (n = 36) and non-peanut-sensitized nonallergic (n = 25) children underwent skin prick test (SPT) and specific IgE (sIgE) to peanut and its components. BAT was performed using flow cytometry, and its diagnostic performance was evaluated in relation to allergy versus tolerance to peanut and validated in an independent population (n = 65). RESULTS BAT in peanut-allergic children showed a peanut dose-dependent upregulation of CD63 and CD203c while there was no significant response to peanut in peanut-sensitized but tolerant (P < .001) and non-peanut-sensitized nonallergic children (P < .001). BAT optimal diagnostic cutoffs showed 97% accuracy, 95% positive predictive value, and 98% negative predictive value. BAT allowed reducing the number of required OFCs by two-thirds. BAT proved particularly useful in cases in which specialists could not accurately diagnose peanut allergy with SPT and sIgE to peanut and to Arah2. Using a 2-step diagnostic approach in which BAT was performed only after equivocal SPT or Arah2-sIgE, BAT had a major effect (97% reduction) on the number of OFCs required. CONCLUSIONS BAT proved to be superior to other diagnostic tests in discriminating between peanut allergy and tolerance, particularly in difficult cases, and reduced the need for OFCs.
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Affiliation(s)
- Alexandra F Santos
- Division of Asthma, Allergy & Lung Biology, Department of Pediatric Allergy, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom; Immunoallergology Department, Coimbra University Hospital, Coimbra, Portugal; Gulbenkian Programme for Advanced Medical Education, Lisbon, Portugal
| | - Abdel Douiri
- Department of Public Health Science, School of Medicine, King's College London, London, United Kingdom; National Institute for Health Research, Biomedical Research Centre, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Natalia Bécares
- Division of Asthma, Allergy & Lung Biology, Department of Pediatric Allergy, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Shih-Ying Wu
- Division of Asthma, Allergy & Lung Biology, Department of Pediatric Allergy, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Alick Stephens
- Division of Asthma, Allergy & Lung Biology, Department of Pediatric Allergy, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Suzana Radulovic
- Division of Asthma, Allergy & Lung Biology, Department of Pediatric Allergy, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Susan M H Chan
- Division of Asthma, Allergy & Lung Biology, Department of Pediatric Allergy, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom; National Institute for Health Research, Biomedical Research Centre, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Adam T Fox
- Division of Asthma, Allergy & Lung Biology, Department of Pediatric Allergy, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - George Du Toit
- Division of Asthma, Allergy & Lung Biology, Department of Pediatric Allergy, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Victor Turcanu
- Division of Asthma, Allergy & Lung Biology, Department of Pediatric Allergy, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Gideon Lack
- Division of Asthma, Allergy & Lung Biology, Department of Pediatric Allergy, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.
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Sun N, Zhou C, Zhou X, Sun L, Che H. Use of a rat basophil leukemia (RBL) cell-based immunological assay for allergen identification, clinical diagnosis of allergy, and identification of anti-allergy agents for use in immunotherapy. J Immunotoxicol 2014; 12:199-205. [PMID: 24920006 DOI: 10.3109/1547691x.2014.920063] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Food allergy is an important public health problem that affects an estimated 8% of young children and 2% of adults. With an increasing interest in genetically-engineered foods, there is a growing need for development of sensitive and specific tests to evaluate potential allergenicity of foods and novel proteins as well as to determine allergic responses to ensure consumer safety. This review covers progress made in the field of development of cell models, specifically that involving a rat basophil leukemia (RBL) cell-based immunoassay, for use in allergen identification, diagnosis, and immunotherapy. The RBL assay has been extensively employed for determining biologically relevant cross-reactivities of food proteins, assessing the effect of processing on the allergenicity of food proteins, diagnosing allergic responses to whole-food products, and identifying anti-allergy food compounds. From the review of the literature, one might conclude the RBL cell-based assay is a better test system when compared to wild-type mast cell and basophil model systems for use in allergen identification, diagnosis, and analyses of potential immunotherapeutics. However, it is important to emphasize that this assay will only be able to identify those allergens to which the human has already been exposed, but will not identify a truly novel allergen, i.e. one that has never been encountered as in its preferred (humanized) configuration.
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Affiliation(s)
- Na Sun
- College of Food Science and Nutritional Engineering, China Agricultural University , Beijing , PR China and
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Kiss-Tóth Dojcsák É, Ferenczi Z, Szalai Juhász A, Kiss-Tóth E, Rácz O, Fodor B. Flow cytometric analysis of the basophil cell activating impact of potential drug delivery nanoparticle-candidate. Acta Microbiol Immunol Hung 2014; 61:49-60. [PMID: 24631753 DOI: 10.1556/amicr.61.2014.1.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Carbon nanotubes – as artificial nano-size ranged materials –have increasing role in the modern biomedical, diagnostic and therapeutic applications.There is a promising option for their use as more potential drug carriers. Despite the favourable properties, their impact (accumulation, elimination, etc.) on biological systems is largely unknown. The main limiting factor of medical use of nanomaterials in most cases is the potential hypersensitive side effect. It can develop in different route, but the activation of basophil granulocytes may play a central role in this process. OBJECTIVE Our aim was to test the direct activation ability of different, surface modified nanotubes on basophil granulocytes in vitro. In parallel we tested the effectiveness of BasoTest planned to use for this study. MATERIALS AND METHODS Using the blood samples of allergic and healthy volunteers we examined the basophil degranulation in the presence of nanotubes and the expression level changes of cell-surface CD63 on FACS Calibur instrument. Our results were compared to positive(fMLP, Mite, Grass) and negative control samples. RESULTS The test we have chosen proved to be sufficiently sensitive and specific for further study. Significant basophil activation was observed in the presence of carbon nanotubes in healthy persons and allergic patients, as well. The activating effect of nanotubes was more prevailed in allergic population. CONCLUSION Our experiments have proven the fact that nanotubes may play a role in the development of hypersensitive allergic reactions through their basophil granulocyte activator effect.
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Affiliation(s)
- Éva Kiss-Tóth Dojcsák
- 1 University of Miskolc Department of Nanobiotechnology and Regenerative Medicine, Faculty of Health Miskolc Hungary
| | - Zoltán Ferenczi
- 1 University of Miskolc Department of Nanobiotechnology and Regenerative Medicine, Faculty of Health Miskolc Hungary
| | - Adrienn Szalai Juhász
- 1 University of Miskolc Department of Nanobiotechnology and Regenerative Medicine, Faculty of Health Miskolc Hungary
| | - Emőke Kiss-Tóth
- 2 University of Miskolc Department of Preventive Health Sciences, Faculty of Health Miskolc Hungary
| | | | - Bertalan Fodor
- 1 University of Miskolc Department of Nanobiotechnology and Regenerative Medicine, Faculty of Health Miskolc Hungary
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Bidad K, Nawijn MC, van Oosterhout AJM, van der Heide S, Elberink JNGO. Basophil activation test in the diagnosis and monitoring of mastocytosis patients with wasp venom allergy on immunotherapy. CYTOMETRY PART B-CLINICAL CYTOMETRY 2014; 86:183-90. [PMID: 24478037 DOI: 10.1002/cyto.b.21148] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 11/27/2013] [Accepted: 12/03/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is need for an accurate diagnostic test in mastocytosis patients with wasp venom allergy (WVA) and monitoring of these patients during immunotherapy (IT). In this study, we aimed to evaluate sensitivity and specificity of the Basophil Activation Test (BAT) as a diagnostic and monitoring test in patients with mastocytosis and WVA. METHODS Seventeen patients with mastocytosis and WVA and six mastocytosis patients without WVA were included. BAT was performed before the start of IT (first visit) and at 6 weeks (second visit) and 1 year (third visit), after reaching the maintenance dose. Of 17 patients included, 11 completed the third visit. In mastocytosis patients with WVA, dose-dependent wasp-venom induced upregulation of CD63 and CD203c expression on basophils was observed compared with mastocytosis patients without WVA. Serum specific IgE, IgG4, and tryptase levels were measured in all patients. RESULTS BAT had a sensitivity of 87% and specificity of 100% in diagnosing WVA in mastocytosis patients. Basophil allergen threshold sensitivity with respect to CD63 and CD203c was significantly decreased in the second visit compared with the first visit and increased significantly in the third visit compared with the second visit. Specific IgE levels increased significantly in the second visit compared with first and decreased significantly in the third visit compared with the second. Specific IgG4 levels rose significantly in the second visit compared with the first and on the third visit compared with the second. Tryptase levels did not change significantly during the study. CONCLUSIONS BAT represents a diagnostic test with 100% specificity in allergic patients with mastocytosis and these patients are better to be monitored for a longer period during IT.
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Affiliation(s)
- Katayoon Bidad
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Pathology and Medical Biology, Laboratory of Allergology and Pulmonary Diseases, University Medical Center of Groningen, University of Groningen, Groningen, The Netherlands
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Leysen J, Sabato V, Verweij MM, De Knop KJ, Bridts CH, De Clerck LS, Ebo DG. The basophil activation test in the diagnosis of immediate drug hypersensitivity. Expert Rev Clin Immunol 2014; 7:349-55. [DOI: 10.1586/eci.11.14] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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79
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Ebo DG, Hagendorens MM, Bridts CH, Stevens WJ. In vitrodiagnosis of IgE-mediated allergy: breakthroughs in the last decade. Expert Rev Clin Immunol 2014; 8:9-11. [DOI: 10.1586/eci.11.73] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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80
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Abstract
The basis of flow cytometric allergy diagnosis is quantification of changes in expression of basophilic surface membrane markers (Ebo et al., Clin Exp Allergy 34: 332-339, 2004). Upon encountering specific allergens recognized by surface receptor FcεRI-bound IgE, basophils not only secrete and generate quantifiable bioactive mediators but also up-regulate the expression of different markers (e.g., CD63, CD203c) which can be detected by multicolor flow cytometry using specific monoclonal antibodies (Ebo et al., Cytometry B Clin Cytom 74: 201-210, 2008). Here, we describe two flow cytometry-based protocols which allow detection of surface marker activation (Method 1) and changes in intragranular histamine (Method 2), both reflecting different facets of basophil activation.
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81
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Carroccio A, Mansueto P, D'Alcamo A, Iacono G. Non-celiac wheat sensitivity as an allergic condition: personal experience and narrative review. Am J Gastroenterol 2013; 108:1845-52; quiz 1853. [PMID: 24169272 DOI: 10.1038/ajg.2013.353] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 09/03/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Non-celiac wheat sensitivity (NCWS) is a newly described clinical entity characterized by symptoms, which can involve the gastrointestinal tract, the nervous system, the skin, and other organs. There is little data on the pathogenesis of NCWS and it is probable that different pathogenic mechanisms are involved in the different clinical manifestations of the disease. The only common denominator of NCWS "syndrome" is wheat consumption: the symptoms disappear on exclusion of wheat from the diet, and reappear on wheat consumption. The objective of this study was to review our prior data regarding NCWS and to review relevant medical literature regarding NCWS, with particular attention to the hypothesis that NCWS patients could suffer from non-immunoglobulin E (IgE)-mediated wheat allergy. METHODS We reviewed our data on 276 patients diagnosed with NCWS by means of double-blind placebo-controlled (DBPC) wheat challenge. The data indicating a possible wheat allergy diagnosis were examined and other data in the literature were reviewed; we review the role of serum immunoglobulin G antibodies and the basophil activation assay in food allergy, and the histology findings in the food allergy diagnosis. RESULTS The comparison between patients suffering from NCWS and presenting with irritable bowel syndrome (IBS) and controls with IBS not due to NCWS showed that NCWS was characterized by: a personal history of food allergy in the pediatric age (0.01), coexistent atopic diseases (0.0001), positive serum anti-gliadin (0.0001) and anti-betalactoglobulin (0.001) antibodies, positive cytofluorimetric assay revealing in vitro basophil activation by food antigens (0.0001), and a presence of eosinophils in the intestinal mucosa biopsies (0.0001). CONCLUSIONS Patients with NCWS and multiple food sensitivity show several clinical, laboratory, and histological characteristics that suggest they might be suffering from non-IgE-mediated food allergy. However, other pathogenic mechanisms need to be considered.
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Affiliation(s)
- Antonio Carroccio
- Internal Medicine, Hospital of Sciacca, ASP Agrigento and University of Palermo, Palermo, Italy
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82
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Song WJ, Chang YS. Recent applications of basophil activation tests in the diagnosis of drug hypersensitivity. Asia Pac Allergy 2013; 3:266-80. [PMID: 24260732 PMCID: PMC3826605 DOI: 10.5415/apallergy.2013.3.4.266] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 10/03/2013] [Indexed: 01/17/2023] Open
Abstract
Immediate-type drug hypersensitivity is an increasingly significant clinical issue; however, the diagnosis is frequently hindered due to lack of safe and precise diagnostic tests. Flow cytometry-assisted basophil activation test is a safe in vitro diagnostic tool for assessing basophil activation upon allergen stimulation. In this review, we have summarized current literature on the diagnostic utilities, new indications, and methodological aspects of the basophil activation test for the diagnosis of drug hypersensitivity.
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Affiliation(s)
- Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 100-799, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 100-799, Korea
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83
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Hagau N, Gherman-Ionica N, Sfichi M, Petrisor C. Threshold for basophil activation test positivity in neuromuscular blocking agents hypersensitivity reactions. Allergy Asthma Clin Immunol 2013; 9:42. [PMID: 24499278 PMCID: PMC4029498 DOI: 10.1186/1710-1492-9-42] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 10/17/2013] [Indexed: 11/10/2022] Open
Abstract
Background Several different criteria for the positivity of the flow-assisted Basophil Activation Test (BAT) for the diagnosis of Neuromuscular Blocking Agents (NMBA) hypersensitivity reactions have been used in past studies. Our aims were to determine the threshold for BAT positivity expressed as the stimulation index (SI, calculated as the percentage of activated basophils after stimulation with NMBA divided by the number of basophils with no NMBA stimulation) and as the percentage of activated basophils, and to determine the sensitivity and specificity of BAT for NMBAs. Methods 22 consenting adult patients with previous intraanaesthetic NMBAs-related hypersensitivity reactions were tested for the culprit drug. 34 controls who tolerated NMBAs were similarly tested. BAT was performed using Flow2Cast technique and the up-regulation of the CD63 marker on the basophils was measured using Cell Quest programme (FACSCalibur Becton Dickinson, USA). Receiver operating characteristics curve (ROC) analysis was performed. Results ROC curve analysis for BAT results versus history yields a stimulation index of 1.76 as the optimal threshold, with an AUC of 0.81 (CI 95% 0.69-0.93, p < 0.01) and a percentage of activated basophils > 5.01%, with an AUC of 0.84 (CI 95% 0.72-0.95, p < 0.01). Considering both thresholds (the SI ≥ 1.76 together with the percentage of activated basophils > 5%) as diagnostic criteria, 15 patients had positive BAT, the overall BAT sensitivity being 68.18% (CI 95% 45.11-82.26%). None of the controls fulfilled both criteria and the specificity of the test was 100% (CI 95% 87.35-100%). Conclusions With a stimulation index ≥ 1.76 and a percentage of activated basophils > 5.01% as threshold, the performance of BAT for NMBAs yields 68.18% sensitivity and 100% specificity.
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Affiliation(s)
- Natalia Hagau
- Department of Anaesthesia and Intensive Care, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
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84
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Peanut protein in household dust is related to household peanut consumption and is biologically active. J Allergy Clin Immunol 2013; 132:630-638. [DOI: 10.1016/j.jaci.2013.02.034] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 02/24/2013] [Accepted: 02/28/2013] [Indexed: 11/16/2022]
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85
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Hagau N, Longrois D, Petrisor C. Threshold for positivity and optimal dipyrone concentration in flow cytometry-assisted basophil activation test. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2013; 5:383-8. [PMID: 24179685 PMCID: PMC3810545 DOI: 10.4168/aair.2013.5.6.383] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 02/08/2013] [Indexed: 11/27/2022]
Abstract
Purpose Basophil activation occurs both in patients with immediate hypersensitivity reactions to anti-inflammatory drugs and in healthy controls in a dose-dependent manner. Our aims were to define the optimal basophil activation test (BAT) concentration and the threshold for BAT positivity for dipyrone. Methods From 45 patients with a positive history of an immediate hypersensitivity reaction to dipyrone, we found 20 patients with dipyrone-induced anaphylaxis demonstrating positive skin tests. All selected patients, as well as 10 healthy controls, were tested in vivo and in vitro. BAT was performed using Flow 2CAST technique with three low dipyrone concentrations: 25 µg/mL (c1), 2.5 µg/mL (c2) and 0.25 µg/mL (c3). The threshold for BAT positivity was established using receiver operating characteristics (ROC) curve analysis. Results Using ROC curve analysis the highest area under curve, 0.79 (0.63-0.95) (P<0.01), was found for c3. When the highest stimulation indexes from the three concentrations for each patient were used, ROC curve analysis revealed an area under curve of 0.81 (0.65-0.96) (P<0.01), sensitivity and specificity were 0.70 and 1 and the optimal threshold value for BAT positivity was 1.71. Thirteen patients had a positive BAT for at least one of the tested dipyrone concentrations. All healthy controls presented negative BAT. Conclusions BAT might be a useful technique to diagnose dipyrone allergy, provided all three low dipyrone concentrations are used together. With an assay-specific threshold of 1.71, ROC curve analysis yields 70% sensitivity and 100% specificity.
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Affiliation(s)
- Natalia Hagau
- Department of Anaesthesia and Intensive Care, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Romania
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86
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Tammaro A, Narcisi A, Amodeo R, Portaro L, Tabacco F, Cardelli P, Persechino S. CD 63 Cell Expression Detected by Flow-Cytometric Determination and Basophil Activation in Allergic Patients. Int J Immunopathol Pharmacol 2012; 25:1143-7. [DOI: 10.1177/039463201202500432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Flow cytometry analysis of in vitro activated basophils (BATs) based on the detection of CD63 up-regulation on basophil membrane provides the physician and the clinical laboratory with a novel diagnostic approach, proposed as a promising alternative method for in vitro diagnosis of IgE and non-mediated reactions. We performed an optimized flow cytometric procedure to assess CD63 expression on activated basophils on twenty allergic patients, and compared the results with specific IgE determination (RAST) and skin testing (Prick test).
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Affiliation(s)
- A. Tammaro
- U.O.C. Dermatology, NESMOS Department, Faculty of Medicine, University of Rome “Sapienza”, Rome, Italy
| | - A. Narcisi
- U.O.C. Dermatology, NESMOS Department, Faculty of Medicine, University of Rome “Sapienza”, Rome, Italy
| | - R. Amodeo
- UOC of Laboratory Diagnostics, Faculty of Medicine, University of Rome “Sapienza”, Rome, Italy
| | - L. Portaro
- UOC of Laboratory Diagnostics, Faculty of Medicine, University of Rome “Sapienza”, Rome, Italy
| | - F. Tabacco
- UOC of Laboratory Diagnostics, Faculty of Medicine, University of Rome “Sapienza”, Rome, Italy
| | - P. Cardelli
- UOC of Laboratory Diagnostics, Faculty of Medicine, University of Rome “Sapienza”, Rome, Italy
| | - S. Persechino
- U.O.C. Dermatology, NESMOS Department, Faculty of Medicine, University of Rome “Sapienza”, Rome, Italy
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87
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Descotes J. Safety immunopharmacology: evaluation of the adverse potential of pharmaceuticals on the immune system. J Pharmacol Toxicol Methods 2012; 66:79-83. [PMID: 22587937 PMCID: PMC7111030 DOI: 10.1016/j.vascn.2012.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 04/24/2012] [Accepted: 05/05/2012] [Indexed: 02/08/2023]
Abstract
The ICH S6R1 and S8 guidelines define a general framework for the immunotoxicity evaluation of biotechnology-derived pharmaceuticals and human pharmaceuticals, respectively. As severe and unpredicted adverse events dramatically showed in the recent years that the immune system is a critical aspect of drug safety, this framework needs to be revisited to enhance the prediction of nonclinical immune safety evaluation. Safety immunopharmacology is deemed to contribute to this awaited improvement by enabling early screening of the potential for drug candidates to induce unexpected immunosuppressive and immunostimulatory effects as well as nonimmune-mediated hypersensitivity reactions. Dedicated safety immunopharmacology can also generate mechanistic data to determine which relevant additional immunotoxicity studies should be conducted. Immunological assays and models that can be considered for use in the context of safety pharmacology studies are presented as well as perspectives for their timely development.
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Affiliation(s)
- Jacques Descotes
- Poison Center and Pharmacovigilance Department, Lyon University Hospitals, and Claude Bernard University, Lyon, France.
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88
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Müller U, Schmid-Grendelmeier P, Hausmann O, Helbling A. IgE to recombinant allergens Api m 1, Ves v 1, and Ves v 5 distinguish double sensitization from crossreaction in venom allergy. Allergy 2012; 67:1069-73. [PMID: 22676144 DOI: 10.1111/j.1398-9995.2012.02847.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diagnostic tests in patients with Hymenoptera venom allergy are frequently positive to venoms of both honey bee and wasp (Vespula). Component-resolved analysis with recombinant species-specific major allergens (rSSMA) may help to distinguish true double sensitization from crossreactivity. METHODS Included were 121 patients with systemic allergic reactions to Hymenoptera stings, 76 with double positivity of serum-specific IgE (sIgE) to both venoms, 45 with single positivity to bee or wasp venom, and 32 controls without history of systemic reactions to Hymenoptera stings and no sIgE to whole venoms. In venom-allergic patients and controls, sIgE to rSSMA Api m 1 of bee venom and to Ves v 1 and Ves v 5 of wasp venom were tested by ImmunoCAP. RESULTS Only 47% of 76 patients with double positivity to whole venoms reacted also to rSSMA of both species. Specificity of sIgE to the 3 rSSMA was very high, with no sIgE to rSSMA of the other species in single-positive venom-allergic patients and only one control with low sIgE to Ves v 1. All wasp-allergic single-positive patients had sIgE to Ves v 5 and/or Ves v 1, and 78.3% of single-positive bee venom-allergic patients had sIgE to Api m 1. CONCLUSION Specificity of sIgE to rSSMA of both species is excellent. Sensitivity of sIgE to rSSMA was optimal for wasp venom. Sensitivity of bee venom Api m 1 could be increased by adding rSSMA of other important bee venom allergens.
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Affiliation(s)
- U. Müller
- Division of Allergy, Department of Medicine; Spital Ziegler; Bern; Switzerland
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89
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Hagau N, Gherman-Ionica N, Hagau D, Tranca S, Sfichi M, Longrois D. Is a positive history of non-anaesthetic drug allergy a predictive factor for positive allergy tests to anaesthetics? Br J Clin Pharmacol 2012; 73:460-6. [PMID: 21988224 DOI: 10.1111/j.1365-2125.2011.04112.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIMS International recommendations stipulate not performing screening skin tests to a drug in the absence of a clinical history consistent with that specific drug allergy. Nevertheless, two publications showed that a positive history of non-anaesthetic drug allergy was the only predictive factor for a positive skin test when screening for allergy to anaesthetic drugs was done. We selected from a surgical population 40 volunteers with a prior history of allergy to non-anaesthetic drugs in order to analyse the prevalence of positive allergy tests to anaesthetics. METHODS The selected adult patients were tested for 11 anaesthetic drugs using in vivo tests: skin prick (SPT) and intradermal (IDT) tests and in vitro tests: the basophil activation test (BAT) and detection of drug-specific immunoglobulin E (IgE). RESULTS The prevalence for the positive SPT and IDT was 1.6% and 5.8% respectively. The result of flow cytometry agreed with the SPT in five out of seven positive SPT (71%). IgEs confirmed two positive SPT with corresponding positive BAT. Ten per cent of the patients had a positive prick test to neuromuscular blocking agents (NMBA). For midazolam none of the SPT was positive, but 11 patients had positive IDT nonconfirmed by BAT. CONCLUSION The prevalence of positive in vivo and in vitro allergy tests to NMBAs is higher in our study population. This could be an argument for pre-operative SPT to NMBAs for the surgical population with reported non-anaesthetic drug allergies. A larger prospective study is needed to validate changes in clinical practice.
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Affiliation(s)
- Natalia Hagau
- Department of Anaesthesia and Intensive Care, University of Medicine and Pharmacy 'Iuliu Hatieganu' Cluj-Napoca, Romania.
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90
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Eržen R, Košnik M, Šilar M, Korošec P. Basophil response and the induction of a tolerance in venom immunotherapy: a long-term sting challenge study. Allergy 2012; 67:822-30. [PMID: 22469017 DOI: 10.1111/j.1398-9995.2012.02817.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is no in vitro test to predict the induction of long-term tolerance in patients treated with venom immunotherapy (VIT). The aim of this study was to investigate whether immunotherapy-induced changes in basophil responsiveness reflect a state of protection and the induction of a tolerance. METHODS Twenty-three patients with allergic reaction after Hymenoptera sting (11 wasp and 12 honeybee) were treated with VIT. In all patients, a CD63 basophil activation test was performed before the beginning of immunotherapy, after 1 year and after completing 4-6.5 years of immunotherapy (approximately 1 year after stopping). The tolerance was then evaluated by a sting challenge test. The basophil activation test was repeated 3-6 months after the challenge. RESULTS Twenty-two subjects showed a negative sting challenge, and one subject, a positive sting challenge. Allergen-specific basophil response remained unchanged after 1 year of immunotherapy. However, after immunotherapy, a significant and approximately fourfold decrease was demonstrated in all tolerant subjects mainly in response to submaximal 0.1 μg/ml allergen concentration. This depression was sustained and did not change with the sting challenge test. In a nontolerant patient with a positive sting challenge, basophil response did not change. CONCLUSIONS Our results suggest that the depression of allergen-specific basophil response seems to be associated with the induction of a tolerance after completing a course of VIT.
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Affiliation(s)
- R. Eržen
- University Clinic of Respiratory and Allergic Diseases; Golnik; Slovenia
| | - M. Košnik
- University Clinic of Respiratory and Allergic Diseases; Golnik; Slovenia
| | - M. Šilar
- University Clinic of Respiratory and Allergic Diseases; Golnik; Slovenia
| | - P. Korošec
- University Clinic of Respiratory and Allergic Diseases; Golnik; Slovenia
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91
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Cucu T, De Meulenaer B, Bridts C, Devreese B, Ebo D. Impact of thermal processing and the Maillard reaction on the basophil activation of hazelnut allergic patients. Food Chem Toxicol 2012; 50:1722-8. [PMID: 22406579 DOI: 10.1016/j.fct.2012.02.069] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 02/21/2012] [Accepted: 02/22/2012] [Indexed: 01/23/2023]
Abstract
Food allergy, an abnormal immunological response due to sensitization to a food component, has become an important health problem, especially in industrialized countries. The aim of this study was to investigate the impact of thermal processing and glycation on the basophil activation by hazelnut proteins using a basophil activation test. Patients with systemic allergic reactions (SR; n=6) to hazelnut as well as patients with an isolated oral allergy syndrome (OAS; n=4) were investigated. Thermal processing of hazelnut proteins either in the presence or absence of wheat proteins did not result in major changes in the stimulatory activity of the basophils for patients with SR or OAS. For the patients with OAS, incubation of hazelnut proteins with glucose led to complete depletion of the stimulatory activity of the basophils. An increase in stimulatory activity of the basophils for two out of six patients with SR was observed. For the other four patients slight or complete abolition of the stimulatory activity was observed. These results indicate that some patients with SR to hazelnut are at risk when exposed to hazelnut proteins, even in processed foods.
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Affiliation(s)
- Tatiana Cucu
- Department of Food Safety and Food Quality, Research Group Food Chemistry and Human Nutrition, Ghent University, Coupure Links 653, B-9000 Gent, Belgium
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92
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Kim MS, Cho YJ. Flow Cytometry-Assisted Basophil Activation Test as a Safe Diagnostic Tool for Aspirin/NSAID Hypersenstivity. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2012; 4:137-42. [PMID: 22548206 PMCID: PMC3328730 DOI: 10.4168/aair.2012.4.3.137] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Revised: 09/28/2011] [Accepted: 10/12/2011] [Indexed: 11/20/2022]
Abstract
Purpose Aspirin and non-steroidal anti-inflammatory drugs (ASA/NSAIDs) are common causes of drug hypersensitivity. An oral provocation test is the only definitive diagnostic test. This study assessed the reliability of a flow cytometry-assisted basophil activation test (FAST) as a safe diagnostic method for ASA/NSAID-induced hypersensitivity, as its high sensitivity and specificity have been demonstrated for many other drugs. Methods Eighteen patients and 11 controls were enrolled. Using a Flow-CAST kit® (Bühlmann Laboratories AG, Schönenbuch, Switzerland), 29 analyses with aspirin, ibuprofen, and diclofenac were performed by flow cytometry to detect double-positive staining of anti-IgE and anti-CD63. The stimulation index was defined as the activated basophil percentage after drug stimulation/basally active basophil percentage. A stimulation index≥2 and an absolute activated basophil percentage≥5 were considered positive. Results Patients with hypersensitivity to ASA/NSAIDs were predominantly female, and the prevalence of atopy was higher in patients than in controls. A sensitivity of 61%, specificity of 91%, positive predictive value of 92%, and negative predictive value of 59% were achieved. Conclusions FAST is a useful additional method for diagnosis of hypersensitivity reactions to ASA/NSAIDs. Further development is required to increase the sensitivity of the test.
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Affiliation(s)
- Myung Shin Kim
- Department of Internal Medicine, Soon Chun Hyang University Gumi Hospital, Gumi, Korea
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93
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Peroni DG, Sansotta N, Bernardini R, Crisafulli G, Franceschini F, Caffarelli C, Boner AL. Muscle relaxants allergy. Int J Immunopathol Pharmacol 2012; 24:S35-46. [PMID: 22014924 DOI: 10.1177/03946320110240s306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The most common agents that are responsible for intraoperative anaphylaxis are muscle relaxants. In fact, neuromuscular blocking agents (NMBAs) contribute to 50-70 percent of allergic reactions during anaesthesia. The main mechanism of hypersensitivity reactions to NMBAs is represented by acute type I allergic reactions and the most severe form is anaphylaxis. The rate of non IgE mediated immediate hypersensitivity reactions usually varies between 20 percent and 35 percent of the reported cases in most large series. In a recent report, non allergic suspected reactions to NMBAs occurred with almost the same frequency as did those with an allergic component. Although the precise mechanisms of these reactions remain difficult to ascertain, they usually result from direct non specific mast cell and basophil activation. After diagnostic procedures, regardless of the specific IgE results, NMBAs are contraindicated if the skin tests were positive. In view of the constantly evolving anesthesiologic practices, and of the complexity of allergy investigation, an active policy to identify patients at risk and to provide any necessary support to anaesthetists and allergologists should be promoted. The high frequency of IgE anaphylactic reactions and the feasibility of skin tests in children justify systematic allergy testing whenever hypersensitivity reaction occurs during general anaesthesia.
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Affiliation(s)
- D G Peroni
- Department of Pediatrics, University of Verona, Verona, Italy.
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94
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Chirumbolo S. Basophil Activation Test in Allergy: Time for an Update? Int Arch Allergy Immunol 2012; 158:99-114. [DOI: 10.1159/000331312] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 07/29/2011] [Indexed: 11/19/2022] Open
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95
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Ebo DG, Bridts CH, Mertens CH, Hagendorens MM, Stevens WJ, De Clerck LS. Analyzing histamine release by flow cytometry (HistaFlow): A novel instrument to study the degranulation patterns of basophils. J Immunol Methods 2012; 375:30-8. [DOI: 10.1016/j.jim.2011.09.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 09/06/2011] [Accepted: 09/06/2011] [Indexed: 11/15/2022]
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96
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Vissers YM, Wichers HJ, Savelkoul HFJ. Influence of Food Processing, Digestion and the Food Matrix on Allergenicity & Cellular Measures of Allergenicity. MULTIDISCIPLINARY APPROACHES TO ALLERGIES 2012. [DOI: 10.1007/978-3-642-31609-8_12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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97
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Sabato V, Verweij MM, Bridts CH, Levi-Schaffer F, Gibbs BF, De Clerck LS, Schiavino D, Ebo DG. CD300a is expressed on human basophils and seems to inhibit IgE/FcεRI-dependent anaphylactic degranulation. CYTOMETRY PART B-CLINICAL CYTOMETRY 2011; 82:132-8. [DOI: 10.1002/cyto.b.21003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 11/17/2011] [Accepted: 11/23/2011] [Indexed: 11/11/2022]
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98
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Gentinetta T, Pecaric-Petkovic T, Wan D, Falcone FH, Dahinden CA, Pichler WJ, Hausmann OV. Individual IL-3 priming is crucial for consistent in vitro activation of donor basophils in patients with chronic urticaria. J Allergy Clin Immunol 2011; 128:1227-1234.e5. [DOI: 10.1016/j.jaci.2011.07.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 07/04/2011] [Accepted: 07/15/2011] [Indexed: 12/19/2022]
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99
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Lee JY, Jin HJ, Park JW, Jung SK, Jang JY, Park HS. A case of korean ginseng-induced anaphylaxis confirmed by open oral challenge and basophil activation test. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 4:110-1. [PMID: 22379608 PMCID: PMC3283793 DOI: 10.4168/aair.2012.4.2.110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 08/04/2011] [Accepted: 08/10/2011] [Indexed: 11/20/2022]
Abstract
Two case reports discussing Korean ginseng-induced allergic reactions have been published; both were inhalation-induced respiratory allergies in occupational settings. In this report we discuss the first case of anaphylaxis that developed after an oral intake of ginseng, confirmed by an open oral challenge, a skin prick test (SPT), and a basophil activation test (BAT). A 44-year-old man experienced rhinorrhea and nasal stiffness, followed by respiratory difficulty with wheeze and abdominal pain 10 minutes after oral intake of fresh ginseng. He had suffered from episodes of allergic rhinitis during the spring season for several years. Upon presentation, a physical examination, chest radiograph, and routine laboratory tests were unremarkable. Total serum IgE level was 41 IU/mL. The SPT results showed strong positive responses to alder, birch pollens, and ginseng extracts (1:500 w/v). The methacholine bronchial challenge test revealed a positive result at PC20 of 5.83 mg/mL. The open oral challenge was performed using 50 g of fresh ginseng and showed immediate onset of facial flushing, cough, respiratory difficulty with wheeze, and abdominal pain combined with a significant decrease in FEV1 levels (54% from the baseline). Serum-specific IgE and IgG4 antibodies were not detectable by enzyme-linked immunosorbent assay. BAT showed a remarkable increase in the expression of CD203c and CD63 with the addition of ginseng extract in a dose-dependent manner, while no changes were noted in the controls. In conclusion, oral intake of Korean ginseng could induce anaphylaxis, which is mediated by non-IgE-dependent direct activation of basophil/mast cells.
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Affiliation(s)
- Jae-Young Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University, School of Medicine, Chuncheon, Korea
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Crameri R. Immunoglobulin E-binding autoantigens: biochemical characterization and clinical relevance. Clin Exp Allergy 2011; 42:343-51. [PMID: 22092496 DOI: 10.1111/j.1365-2222.2011.03878.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 07/20/2011] [Accepted: 09/02/2011] [Indexed: 01/14/2023]
Abstract
Although immediate-Type I skin reactions to human dander have been described six decades ago, only the recent application of molecular biology to allergology research allowed fast and detailed characterization of IgE-binding autoantigens. These can be functionally subdivided into three classes: (1) self-antigens with sequence homology to environmental allergens belonging to the class of phylogenetically conserved proteins, (2) self-antigens without sequence homology to known environmental allergens, and (3) chemically modified self-antigens deriving from workplace exposure. As environmental allergens, also IgE-binding autoantigens belong to different protein families without common structural features that would explain their IgE-binding capability. Many of the self-antigens showing sequence homology to environmental allergens, are phylogenetically conserved proteins like manganese dependent superoxide dismutase, thioredoxin or cyclopilin. Their IgE-binding capability can be explained by molecular mimicry resulting from shared B-cell epitopes. A common factor of IgE-binding self-antigens without sequence homology to known environmental allergens is that they elicit IgE responses only in individuals suffering from long-lasting atopic diseases. In contrast, IgE-mediated reactions to modified self-antigens might be explained with the generation of novel B-cell epitopes. Chemically modified self-antigens are likely to be recognized as non-self by the immune system. The clinical relevance of IgE responses to self-antigens remains largely unclear. Well documented is their ability to induce immediate Type I skin reactions in vivo, and to induce mediator release from effector cells of sensitized individuals in vitro. Based on these observations it is reasonable to assume that IgE-mediated cross-linking of FcRIε receptors on effector cells can elicit the same symptoms as those induced by environmental allergens, and this could explain exacerbations of chronic allergic diseases in the absence of external exposure. However, because most of the described IgE-binding self-antigens are intracellular proteins normally not accessible for antigen-antibody interactions, local release of the antigens is required to explain the induction of symptoms.
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Affiliation(s)
- R Crameri
- Department Molecular Allergology, Swiss Institute of Allergy and Asthma Research, Obere Strasse 22, CH-7270 Davos, Switzerland.
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