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Bychkova NV, Selivanov PA, Kalinina NM. Clinical implication of detecting sensitization to iodinated radiocontrast media in the basophil activation test by flow cytometry. Klin Lab Diagn 2021; 66:747-754. [PMID: 35020288 DOI: 10.51620/0869-2084-2021-66-12-747-754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The use of iodinated radiocontrast media is necessary for visualization. A number of patients have adverse effects of various nature and severity when these drugs are administered. Routine allergy tests do not provide adequate diagnosis of reactions to drugs in this group. The aim of this work is to assess the capabilities of the basophil activation test to confirm sensitization to non-ionic iodinated radiocontrast media, as well as to select a safe alternative drug in patients with a burdened history. Basophil activation test by flow cytometry was performed in 184 patients The Nikiforov Russian Centre of Emergency and Radiation Medicine» EMERCOM of Russia and 32 volunteers using ultravist, omnipack, and optiray. The presence of sensitization was assessed based on the basophil activation index, as well as spontaneous and anti-IgE antibody-induced activation of basophils and the population of T-lymphocytes type 2 immune response. The volunteers showed no sensitization to iodinated radiocontrast media. In patients with a medium degree of hypersensitivity reaction in vivo, in vitro sensitization to drugs was detected 4 times more often than in patients with a mild degree (51% versus 13.5%). In patients with systemic reactions to the administration of a known drug, in vitro sensitization was confirmed in 86% of cases, while the frequency of detection of sensitization to drugs did not differ. Spontaneous activation of basophils in patients and type 2 T-lymphocytes were 2 times higher than in volunteers. Patients were more likely to have low (less than 30%) activation of basophils for anti-IgE antibodies. The specificity of the basophil activation test with iodinated radiocontrast media was 100% with a sensitivity of 94.1%. Most patients were able to select a non-sensitizing contrast. Inclusion in the algorithm of spontaneous and anti-IgE antibody-induced activation of basophils and a population of T-lymphocytes type 2 immune response will allow the doctor to carry out a personalized approach to the management of patients with a burdened history.
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Affiliation(s)
- N V Bychkova
- The Nikiforov Russian Centre of Emergency and Radiation Medicine» EMERCOM of Russia.,Saint-Petersburg State Medical University named after I.P. Pavlov the Ministry of Russian Federation for Medicine
| | - P A Selivanov
- Third Military Hospital of the National Guard Troops of the Russian Federation
| | - N M Kalinina
- The Nikiforov Russian Centre of Emergency and Radiation Medicine» EMERCOM of Russia.,Saint-Petersburg State Medical University named after I.P. Pavlov the Ministry of Russian Federation for Medicine
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Mayorga C, Fernandez TD, Montañez MI, Moreno E, Torres MJ. Recent developments and highlights in drug hypersensitivity. Allergy 2019; 74:2368-2381. [PMID: 31557314 DOI: 10.1111/all.14061] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 12/12/2022]
Abstract
Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management. Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication. Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de-labelling of patients previously false-reported as allergic, which will improve the management and treatment of patients with DHRs.
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Affiliation(s)
- Cristobalina Mayorga
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyAL Málaga Spain
- Allergy Unit Hospital Regional Universitario de Málaga‐ARADyAL Málaga Spain
- Andalusian Center for Nanomedicine and Biotechnology‐BIONAND Málaga Spain
| | - Tahia D. Fernandez
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyAL Málaga Spain
| | - Maria Isabel Montañez
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyAL Málaga Spain
- Andalusian Center for Nanomedicine and Biotechnology‐BIONAND Málaga Spain
| | - Esther Moreno
- Allergy Unit Hospital Universitario de Salamanca‐ARADyAL IBSAL Salamanca Spain
| | - María José Torres
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyAL Málaga Spain
- Allergy Unit Hospital Regional Universitario de Málaga‐ARADyAL Málaga Spain
- Andalusian Center for Nanomedicine and Biotechnology‐BIONAND Málaga Spain
- Universidad de Málaga Málaga Spain
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3
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Moreno E, Gracia-Bara MT, Mayorga C, Lázaro M, Campanón MV, Dávila I. Hypersensitivity Reactions to Iodinated Contrast Media: Is it a True Allergy? CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0154-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Steiner M, Harrer A, Himly M. Basophil Reactivity as Biomarker in Immediate Drug Hypersensitivity Reactions-Potential and Limitations. Front Pharmacol 2016; 7:171. [PMID: 27378928 PMCID: PMC4911350 DOI: 10.3389/fphar.2016.00171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/03/2016] [Indexed: 12/17/2022] Open
Abstract
Immediate drug hypersensitivity reactions (DHRs) resemble typical immunoglobulin E (IgE)-mediated symptoms. Clinical manifestations range from local skin reactions, gastrointestinal and/or respiratory symptoms to severe systemic involvement with potential fatal outcome. Depending on the substance group of the eliciting drug the correct diagnosis is a major challenge. Skin testing and in vitro diagnostics are often unreliable and not reproducible. The involvement of drug-specific IgE is questionable in many cases. The culprit substance (parent drug or metabolite) and potential cross-reacting compounds are difficult to identify, patient history and drug provocation testing often remain the only means for diagnosis. Hence, several groups proposed basophil activation test (BAT) for the diagnosis of immediate DHRs as basophils are well-known effector cells in allergic reactions. However, the usefulness of BAT in immediate DHRs is highly variable and dependent on the drug itself plus its capacity to spontaneously conjugate to serum proteins. Stimulation with pure solutions of the parent drug or metabolites thereof vs. drug-protein conjugates may influence sensitivity and specificity of the test. We thus, reviewed the available literature about the use of BAT for diagnosing immediate DHRs against drug classes such as antibiotics, radio contrast media, neuromuscular blocking agents, non-steroidal anti-inflammatory drugs, and biologicals. Influencing factors like the selection of stimulants or of the identification and activation markers, the stimulation protocol, gating strategies, and cut-off definition are addressed in this overview on BAT performance. The overall aim is to evaluate the suitability of BAT as biomarker for the diagnosis of immediate drug-induced hypersensitivity reactions.
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Affiliation(s)
- Markus Steiner
- Division Allergy and Immunology, Department Molecular Biology, University of SalzburgSalzburg, Austria; Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical UniversitySalzburg, Austria
| | - Andrea Harrer
- Division Allergy and Immunology, Department Molecular Biology, University of SalzburgSalzburg, Austria; Department Neurology, Paracelsus Medical UniversitySalzburg, Austria
| | - Martin Himly
- Division Allergy and Immunology, Department Molecular Biology, University of Salzburg Salzburg, Austria
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5
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Palomares O, Crameri R, Rhyner C. The contribution of biotechnology toward progress in diagnosis, management, and treatment of allergic diseases. Allergy 2014; 69:1588-601. [PMID: 25307026 DOI: 10.1111/all.12533] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2014] [Indexed: 12/18/2022]
Abstract
'Biotechnology' has been intuitively used by humans since thousands of years for the production of foods, beverages, and drugs based on the experience without any scientific background. However, the golden era of this discipline emerged only during the second half of the last century. Incredible progresses have been achieved on all fields starting from the industrialization of the production of foods to the discovery of antibiotics, the decipherment of the genetic code, and rational approaches to understand and define the status we now call 'healthy'. The extremely complex interactions between genetic background, life style, and environmental factors influencing our continuously increasing life span have become more and more evident and steadily generate new questions which are only partly answered. Here, we try to summarize the contribution of biotechnology to our understanding, control, and cure of IgE-mediated allergic diseases. We are aware that a review of such a vast topic can never cover all aspects of the progress achieved in the different fields.
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Affiliation(s)
- O. Palomares
- Department of Biochemistry and Molecular Biology; School of Chemistry; Complutense University of Madrid; Madrid Spain
| | - R. Crameri
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zürich; Davos Switzerland
| | - C. Rhyner
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zürich; Davos Switzerland
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Abstract
Skin diseases with an allergic background such as atopic dermatitis, allergic contact dermatitis, and urticaria are very common. Moreover, diseases arising from a dysfunction of immune cells and/or their products often manifest with skin symptoms. This review aims to summarize recently published articles in order to highlight novel research findings, clinical trial results, and current guidelines on disease management. In recent years, an immense progress has been made in understanding the link between skin barrier dysfunction and allergic sensitization initiating the atopic march. In consequence, new strategies for treatment and prevention have been developed. Novel pathogenic insights, for example, into urticaria, angioedema, mastocytosis, led to the development of new therapeutic approaches and their implementation in daily patient care. By understanding distinct pathomechanisms, for example, the role of IL-1, novel entities such as autoinflammatory diseases have been described. Considerable effort has been made to improve and harmonize patient management as documented in several guidelines and position papers.
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Affiliation(s)
- C. Schlapbach
- Department of Dermatology, Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - D. Simon
- Department of Dermatology, Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
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Ramírez E, Tong HY, Fiandor A, Martín-Hervás C, Rivero D, Oñate M, Rueda C, Cabañas R, Moro M, Tapia M, Fernández A, Morón S, Herrero A, Garzón G, Quirce S, Frías J. Hypersensitivity reactions to contrast media injections: a nested case-control study. Ann Allergy Asthma Immunol 2014; 113:488-9.e5. [PMID: 25155086 DOI: 10.1016/j.anai.2014.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Elena Ramírez
- Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Hoi Y Tong
- Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Ana Fiandor
- Department of Allergy, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | | | - Daniela Rivero
- Department of Allergy, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Marta Oñate
- Department of Radiology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Cristina Rueda
- Department of Pharmacy, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Rosario Cabañas
- Department of Allergy, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Marta Moro
- Department of Pharmacy, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Mar Tapia
- Department of Radiology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Amelia Fernández
- Department of Radiology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Sara Morón
- Department of Radiology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Alicia Herrero
- Department of Pharmacy, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Gonzalo Garzón
- Department of Radiology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Santiago Quirce
- Department of Allergy, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Jesús Frías
- Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
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