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Detection of drug-specific immunoglobulin E (IgE) and acute mediator release for the diagnosis of immediate drug hypersensitivity reactions. J Immunol Methods 2021; 496:113101. [PMID: 34273396 DOI: 10.1016/j.jim.2021.113101] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 12/11/2022]
Abstract
The diagnosis of a drug hypersensitivity reaction (DHR) is complex. The first step after taking the clinical history is to look for a sensitization to confirm or exclude the diagnosis and to identify the culprit drug. Skin tests are the primary means of detecting sensitization in DHR, but are associated with a risk for a severe reaction and may be contraindicated. In vitro tests offer the potential to support or confirm a diagnosis of DHR and influence medical decision making. For immediate-type DHR, a few validated assays for measurement of specific IgE (sIgE) are commercially available to a limited number of drugs. In addition, several home-made sIgE radioimmunoassays have been used in other studies. The sensitivity of the sIgE assay is drug-dependant and generally low (0-85%) for betalactams and reported heterogeneous for other drugs ranging from 26% for chlorhexidine and 44% for suxamethonium to 92% for chlorhexidine. However, as all these studies included patients, in whom DHR was confirmed only by skin tests and not by provocation, the results have to be interpreted carefully and may be unreliable. Determination of mediators during an acute phase of a reaction may indirectly support the diagnosis of a DHR by demonstrating mast cell and basophil mediator release. Negative in vitro tests do not exclude a DHR or imputability of a drug, but a positive result may support causality and eliminate the necessity for a drug provocation test. Unfortunately, evidence is limited with a lack of well-controlled studies in larger numbers of well-phenotyped patients, which results in susceptibility for bias and a need for future multicenter studies.
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2
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Mayorga C, Ebo DG, Lang DM, Pichler WJ, Sabato V, Park MA, Makowska J, Atanaskovic-Markovic M, Bonadonna P, Jares E. Controversies in drug allergy: In vitro testing. J Allergy Clin Immunol 2019; 143:56-65. [DOI: 10.1016/j.jaci.2018.09.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/18/2018] [Accepted: 09/28/2018] [Indexed: 12/17/2022]
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3
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Mayorga C, Doña I, Perez-Inestrosa E, Fernández TD, Torres MJ. The Value of In Vitro Tests to DiminishDrug Challenges. Int J Mol Sci 2017; 18:ijms18061222. [PMID: 28590437 PMCID: PMC5486045 DOI: 10.3390/ijms18061222] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 01/30/2023] Open
Abstract
Drug hypersensitivity reactions have multiple implications for patient safety and health system costs, thus it is important to perform an accurate diagnosis. The diagnostic procedure includes a detailed clinical history, often unreliable; followed by skin tests, sometimes with low sensitivity or unavailable; and drug provocation testing, which is not risk-free for the patient, especially in severe reactions. In vitro tests could help to identify correctly the responsible agent, thus improving the diagnosis of these reactions, helping the physician to find safe alternatives, and reducing the need to perform drug provocation testing. However, it is necessary to confirm the sensitivity, specificity, negative and positive predictive values for these in vitro tests to enable their implementation in clinical practice. In this review, we have analyzed these parameters from different studies that have used in vitro test for evaluating drug hypersensitivity reactions and estimated the added value of these tests to the in vivo diagnosis.
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Affiliation(s)
- Cristobalina Mayorga
- Research Laboratory-Allergy Unit, Biomedical Institute of Málaga-IBIMA, Regional University Hospital of Malaga-UMA, Málaga 29009, Spain.
- Allergy Service, IBIMA-Regional University Hospital of Malaga-UMA, Málaga 29009, Spain.
| | - Inmaculada Doña
- Allergy Service, IBIMA-Regional University Hospital of Malaga-UMA, Málaga 29009, Spain.
| | - Ezequiel Perez-Inestrosa
- Department of Organic Chemistry, University of Málaga, Biomedical Institute of Málaga-IBIMA, Málaga 29071, Spain.
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga 29590, Spain.
| | - Tahia D Fernández
- Research Laboratory-Allergy Unit, Biomedical Institute of Málaga-IBIMA, Regional University Hospital of Malaga-UMA, Málaga 29009, Spain.
| | - Maria J Torres
- Allergy Service, IBIMA-Regional University Hospital of Malaga-UMA, Málaga 29009, Spain.
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga 29590, Spain.
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Mayorga C, Celik G, Rouzaire P, Whitaker P, Bonadonna P, Rodrigues-Cernadas J, Vultaggio A, Brockow K, Caubet JC, Makowska J, Nakonechna A, Romano A, Montañez MI, Laguna JJ, Zanoni G, Gueant JL, Oude Elberink H, Fernandez J, Viel S, Demoly P, Torres MJ. In vitro tests for drug hypersensitivity reactions: an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy 2016; 71:1103-34. [PMID: 26991315 DOI: 10.1111/all.12886] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2016] [Indexed: 12/15/2022]
Abstract
Drug hypersensitivity reactions (DHRs) are a matter of great concern, both for outpatient and in hospital care. The evaluation of these patients is complex, because in vivo tests have a suboptimal sensitivity and can be time-consuming, expensive and potentially risky, especially drug provocation tests. There are several currently available in vitro methods that can be classified into two main groups: those that help to characterize the active phase of the reaction and those that help to identify the culprit drug. The utility of these in vitro methods depends on the mechanisms involved, meaning that they cannot be used for the evaluation of all types of DHRs. Moreover, their effectiveness has not been defined by a consensus agreement between experts in the field. Thus, the European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology has organized a task force to provide data and recommendations regarding the available in vitro methods for DHR diagnosis. We have found that although there are many in vitro tests, few of them can be given a recommendation of grade B or above mainly because there is a lack of well-controlled studies, most information comes from small studies with few subjects and results are not always confirmed in later studies. Therefore, it is necessary to validate the currently available in vitro tests in a large series of well-characterized patients with DHR and to develop new tests for diagnosis.
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Affiliation(s)
- C. Mayorga
- Research Laboratory; IBIMA-Regional University Hospital of Malaga-UMA; Malaga Spain
- Allergy Unit; IBIMA-Regional University Hospital of Malaga-UMA; Malaga Spain
| | - G. Celik
- Division of Immunology and Allergy; Department of Chest Diseases; Ankara University School of Medicine; Ankara Turkey
| | - P. Rouzaire
- Department of Immunology and ERTICa Research Group; University Hospital of Clermont-Ferrand and Auvergne University; Clermont-Ferrand France
| | - P. Whitaker
- Regional Adult Cystic Fibrosis Unit; St James's Hospital; Leeds UK
| | - P. Bonadonna
- Allergy Unit; Azienda Ospedaliera Universitaria Intergata of Verona; Verona Italy
| | - J. Rodrigues-Cernadas
- Immunoallergology Department; Faculty of Medicine; Centro Hospitalar São João; Porto Portugal
| | - A. Vultaggio
- Immunoallergology Unit; Department of Biomedicine; Careggi Hospital; Florence Italy
| | - K. Brockow
- Department of Dermatology and Allergology Biederstein; Technische Universität München; Munich Germany
| | - J. C. Caubet
- Pediatric Allergy Unit; Department of Child and Adolescent; University Hospitals of Geneva; Geneva Switzerland
| | - J. Makowska
- Department of Immunology, Rheumatology and Allergy; Healthy Ageing Research Center; Medical University of Łódź; Łódź Poland
| | - A. Nakonechna
- Allergy and Immunology Clinic; Royal Liverpool and Broadgreen University Hospital; Liverpool UK
| | - A. Romano
- Allergy Unit Complesso Integrato Columbus; Rome and IRCCS Oasi Maria S.S.; Troina Italy
| | - M. I. Montañez
- BIONAND-Andalusian Centre for Nanomedicine and Biotechnology; Malaga Spain
| | - J. J. Laguna
- Allergy Unit; Hospital de la Cruz Roja; Madrid Spain
| | - G. Zanoni
- Section of Immunology; Department of Pathology and Diagnostics; University of Verona; Verona Italy
| | - J. L. Gueant
- Department of Molecular Medicine and Personalized Therapeutics and Inserm UMRS 954N-GERE (Nutrition-Genetics-Environmental Risks); University Hospital of Nancy and University of Lorraine; Nancy France
| | - H. Oude Elberink
- Department of Allergology; GRIAC Research Institute; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - J. Fernandez
- Allergy Section; Alicante University Hospital; UMH; Alicante Spain
| | - S. Viel
- Laboratory of Immunology; Centre Hospitalier Lyon Sud; Hospices Civils de Lyon; Lyon France
| | - P. Demoly
- Hôpital Arnaud de Villeneuve; University Hospital of Montpellier, and Sorbonne Universités; UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR; Paris France
| | - M. J. Torres
- Allergy Unit; IBIMA-Regional University Hospital of Malaga-UMA; Malaga Spain
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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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6
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Möbs C, Pfützner W. Cellular in vitro diagnosis of adverse drug reactions. ACTA ACUST UNITED AC 2014; 23:164-171. [PMID: 26120528 PMCID: PMC4479488 DOI: 10.1007/s40629-014-0020-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/08/2014] [Indexed: 12/11/2022]
Abstract
Adverse drug reactions can manifest clinically in a variety of ways. Whilst the majority can be explained by dose-dependent side effects, there is group of unpredictable immunological or non-immunological intolerances that represent a particular diagnostic challenge. Skin tests are frequently negative, whilst challenge tests are time-consuming and often hazardous. Against this backdrop, cellular in vitro tests play a particularly important role in the identification of the causative drug. Whilst basophil tests can be used in the case of immunoglobulin E (IgE)- as well as non-IgE-mediated hypersensitivity reactions, T-cellular test methods assist in the diagnosis of drug eruptions. The reliability of individual tests can be affected by a variety of parameters, such as the pathomechanism underlying the drug reaction, the causative medication, or the point in time of testing. Not only is a sound knowledge of the basic principles of the individual assays an essential prerequisite for correctly indicating and interpreting this test method, but also an awareness of these additional factors.
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Affiliation(s)
- Christian Möbs
- Department of Dermatology and Allergology, Allergy Center Hessen, Philipps University Marburg, Marburg, Germany
| | - Wolfgang Pfützner
- Department of Dermatology and Allergology, Allergy Center Hessen, Philipps University Marburg, Marburg, Germany ; Clinical & Experimental Allergy, Allergy Center Hessen, Department of Dermatology and Allergology, Philipps-University Marburg, Baldingerstraße, 35043 Marburg, Germany
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7
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Zelluläre In-vitro-Diagnostik von Arzneimittelreaktionen. ALLERGO JOURNAL 2014. [DOI: 10.1007/s15007-014-0617-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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8
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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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9
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Mertes PM, Demoly P, Malinovsky JM. Complications anaphylactiques et anaphylactoïdes de l’anesthésie générale. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s0246-0289(12)59003-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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10
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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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11
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Guilloux L, Benoit Y, Aimone-Gastin I, Ponvert C, Beaudouin E. [Control of the biological diagnostic assessment. Immunoglobulin E]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2011; 30:294-304. [PMID: 21392931 DOI: 10.1016/j.annfar.2010.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- L Guilloux
- Unité d'immuno-allergologie, laboratoire Mérieux, avenue Tony-Garnier, Lyon, France.
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12
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Mertes PM, Tajima K, Regnier-Kimmoun MA, Lambert M, Iohom G, Guéant-Rodriguez RM, Malinovsky JM. Perioperative anaphylaxis. Med Clin North Am 2010; 94:761-89, xi. [PMID: 20609862 DOI: 10.1016/j.mcna.2010.04.002] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The incidence of immune-mediated anaphylaxis during anesthesia ranges from 1 in 10,000 to 1 in 20,000. Neuromuscular blocking agents are most frequently incriminated, followed by latex and antibiotics, although any drug or substance used may be a culprit. Diagnosis relies on tryptase measurements at the time of the reaction and skin tests, specific immunoglobulin E, or basophil activation assays. Treatment consists of rapid volume expansion and epinephrine administration titrated to symptom severity.
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Affiliation(s)
- P M Mertes
- Service d'Anesthésie-Réanimation Chirurgicale, CHU de Nancy, Hôpital Central, 29 Avenue de Lattre de Tassigny, 54035 Nancy Cedex, France.
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13
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Mertes PM, Lambert M, Regnier MA, Guéant-Rodriguez RM, Aimone-Gastin I, Mouton-Faivre C, Moneret-Vautrin DA, Malinovsky JM, Guéant JL, Demoly P. Quel bilan pratiquer au décours d’un choc anaphylactique périopératoire ? REVUE FRANCAISE D ALLERGOLOGIE 2009. [DOI: 10.1016/j.reval.2009.01.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Mertes P, Lambert M, Guéant-Rodriguez R, Aimone-Gastin I, Mouton-Faivre C, Moneret-Vautrin D, Guéant J, Malinovsky J, Demoly P. Perioperative Anaphylaxis. Immunol Allergy Clin North Am 2009; 29:429-51. [DOI: 10.1016/j.iac.2009.04.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Romano A, Guéant-Rodriguez RM, Viola M, Gaeta F, Caruso C, Guéant JL. Cross-reactivity among drugs: clinical problems. Toxicology 2005; 209:169-79. [PMID: 15767031 DOI: 10.1016/j.tox.2004.12.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cross-reactivity among drugs is either mediated by immunologic mechanisms or not. The former kind is usually explained by the presence of common antigenic determinants in the cross-reacting drugs. In the case of compounds provoking non-allergic hypersensitivity reactions, cross-reactivity is explained by a common pharmacological characteristic, such as the inhibitory effect of non-steroidal anti-inflammatory drugs on cyclooxygenase-1 and the capability of muscle relaxants or contrast media to release histamine through a non-immunologic mechanism. The main clinical problem deriving from cross-reactivity among drugs is the compelling need to choose a potentially cross-reactive compound and, therefore, to assess cross-reactivity by diagnostic tests. In choosing alternative compounds, skin testing has been used in evaluating IgE-mediated cross-reactivity between penicillins and cephalosporins, as well as among muscle relaxants. In assessing T cell-mediated cross-reactivity among contrast media, corticosteroids, anticonvulsants and heparins, delayed-reading intradermal tests and patch tests, together with lymphocyte transformation tests, can be performed. Because of the limited sensitivity of in vivo and in vitro testing, the most prudent way of establishing the tolerability of a compound of the same group in patients who especially require one is a graded challenge when other allergologic tests are negative.
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Affiliation(s)
- Antonino Romano
- Department of Internal Medicine and Geriatrics, UCSC-Allergy Unit, Unità di Allergologia, Complesso Integrato Columbus, Via G. Moscati 31, 00168 Rome, Italy.
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Abstract
Neuromuscular blocking agents (NMBAs) play a predominant role in the incidence of severe adverse reactions occurring during anesthesia. Most hypersensitivity reactions are of immunologic origin (IgE-mediated) or are related to direct stimulation of histamine release. The incidence of IgE-mediated hypersensitivity or anaphylaxis is estimated between 1 in 10,000 and 1 in 20,000 anesthesias, and NMBAs represent the most frequently involved substances, with a range of 50% to 70%. Any suspected anaphylactic reaction must be extensively investigated using combined perioperative and postoperative testing. Because of the frequent cross-reactivity observed with muscle relaxants, every available NMBA should be tested. This should help provide documented advice for future administration of anesthesia. There is no demonstrated evidence for systematic preoperative screening in the general population at this time. Other well-known adverse effects have been described, such as the succinylcholine-triggered cytotoxic effects on muscle cells, but these are responsible for characteristic clinical symptoms, which are usually easy to distinguish from anaphylactic reactions
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Affiliation(s)
- Paul-Michel Mertes
- Département d'Anesthésie-réanimation, CHU de Nancy, Hôpital Central, 29 Avenue de Lattre de Tassigny, 54035 Nancy Cedex, France.
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17
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Mertes PM, Dewachter P, Laxenaire MC. Complications anaphylactiques et anaphylactoïdes de l'anesthésie générale. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/s0246-0289(03)00098-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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18
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Kanny G, Flabbée J, Morisset M, Moneret Vautrin DA. Allergy to quinine and tonic water. Eur J Intern Med 2003; 14:395-396. [PMID: 14769503 DOI: 10.1016/s0953-6205(03)90011-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2002] [Accepted: 06/10/2003] [Indexed: 11/17/2022]
Affiliation(s)
- Giséle Kanny
- Clinical Immunology and Allergy, Department of Internal Medicine, University Hospital, Hôpital Central, 29 avenue de Lattre de Tassigny, 54035 Nancy Cedex, France
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Abstract
The diagnosis of allergic reactions in clinical practice is based on both clinical history and the determination of specific immunoglobulin E (IgE), either in the serum or on skin mast cells. However, for various reasons, identification of the causative factors is not possible in all the cases. Moreover, not all allergies are IgE-dependent. In an attempt to find sensitive, specific and cost-effective methods to investigate hypersensitivity reactions, in vitro tests were developed at a very early stage. Allergen-induced mediator release assays analyze the mediator released from effector cells, mainly peripheral blood cells, when stimulated in vitro with serial dilutions of the putative allergens. Described initially as research tools, they could well become diagnostic tests. However, relatively few high quality reports have been published so far. In this review, we will detail allergen-dependent histamine, tryptase, arachidonic acid metabolite, e.g. cysteinyl leukotrienes and 15-hydroxyeicosatetraenoic mediator release tests.
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Affiliation(s)
- P Demoly
- Maladies Respiratoires - INSERM U454, CHU de Montpellier, Cedex, France
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20
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Bellou A, Saint-Laudy J, Knippels L, Montémont C, Vauthier E, Gerard P, Pellegrom H, Koerkamp EK, Lesesve JF, Guéant JL, Lambert H, Mallié JP. Brown Norway rat ovalbumin-specific immunoglobulin E antibodies increase the human basophil expression of CD63 marker. Scand J Immunol 2003; 57:271-8. [PMID: 12641656 DOI: 10.1046/j.1365-3083.2003.01233.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Anaphylactic shock is an immunoglobulin E (IgE)-dependent hypersensitivity. Biological tests like leucocyte histamine release (LHR) and human basophil activation (HBA), frequently used in human allergy, reflect both the amount of IgE fixed on cells and the cellular reactivity. To assess whether serum-specific IgE from Brown Norway (BN) rats prepared for ovalbumin (OVA)-induced anaphylactic shocks can activate human basophils which has a potential interest in experimental allergy: such a test could rapidly assert an IgE sensitization in laboratory animals genetically T-helper 2 (Th2)-predisposed. Rats (n = 39) were immunized three times (day 0, day 5 and day 21) with OVA injected subcutaneously. One week after the third immunization, a shock was induced with an intravenous (i.v.) bolus of OVA. Sensitization was assessed by passive cutaneous anaphylaxis (PCA) test and dosages of serum IgE antibodies anti-OVA by enzyme-linked immunosorbent assay. Blood basophils were counted before and during the shock. Before the shock induction (at day 21), an LHR test was performed on rat blood, and human basophils were sensitized with rat sera. HBA was demonstrated by the increase in the percentage of cells expressing CD63 antigen membrane, measured by flow cytometry. Twenty-one days after the first subcutaneous (s.c.) immunization, the rat serum induced a significant HBA. HBA was observed neither with the same serum previously heated nor with the serum from nonimmunized rats (NIRs). OVA-specific IgEs were significantly increased in immunized rat (IR) serum. The PCA test was negative when the serum was previously heated (56 degrees C). We never observed any circulating basophils, and LHR test was negative. After OVA i.v. administration, all IRs died rapidly. HBA testing strongly suggests a mediation by specific IgE in the increase of CD63 in BN rats. Thus, HBA test seems useful in assessing whether an experimental allergy was induced in animals genetically predisposed to an immune response, Th2-mediated, like BN rat. We also conclude that rat basophil activation does not participate in the histamine release during anaphylactic shock in sensitized BN rats.
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Affiliation(s)
- A Bellou
- Laboratoire de Néphrologie Expérimentale, UPRESS-JE2165, Faculté de Médecine de Nancy, Vandoeuvre les Nancy, France.
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Moneret-Vautrin DA. [Cross reactions to curare agents and prediction of their safe use]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2002; 21 Suppl 1:108s-112s. [PMID: 12091975 DOI: 10.1016/s0750-7658(02)00593-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- D A Moneret-Vautrin
- Service de médecine interne, immunologie clinique et allergologie, hôpital central, avenue du Maréchal de Lattre-de-Tassigny, 54035 Nancy, France.
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Laroche D, Guilloux L, Guéant JL. [Comments on diagnosis of anphylactoid reactions. Diagnostic tests in vitro]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2002; 21 Suppl 1:73s-96s. [PMID: 12091989 DOI: 10.1016/s0750-7658(01)00565-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- D Laroche
- Laboratoire de biophysique, radio-isotopes radio-immunologie, CHRU, avenue Côte-de-Nacre, 14033 Caen, France
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Kanny G, Beaudouin E, Moneret-Vautrin DA. IgE-mediated allergy to granisetron and safe use of ondansetron. J Allergy Clin Immunol 2001; 108:1059-60. [PMID: 11742289 DOI: 10.1067/mai.2001.119744] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Affiliation(s)
- M Morisset
- Médecine D, Hôpital Central, Nancy, France.
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Guéant JL, Mata E, Namour F, Romano A, Aimone-Gastin I, Kanny G, Moneiet-Vautrin D, Laxenaire MC. Criteria of evaluation and of interpretation of Sepharose drug IgE-RIA to anaesthetic drugs. Allergy 1999. [DOI: 10.1111/j.1398-9995.1999.tb04743.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Guéant JL, Mata E, Namour F, Romano A, Aimone-Gastin I, Kanny G, Moneiet-Vautrin D, Laxenaire MC. Criteria of evaluation and of interpretation of Sepharose drug IgE-RIA to anaesthetic drugs. Allergy 1999. [DOI: 10.1111/j.1398-9995.1999.tb04727.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Demoly P, Lebel B, Messaad D, Sahla H, Rongier M, Daurès JP, Godard P, Bousquet J. Predictive capacity of histamine release for the diagnosis of drug allergy. Allergy 1999; 54:500-6. [PMID: 10380783 DOI: 10.1034/j.1398-9995.1999.00020.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The diagnosis of immediate allergic reactions to drugs is difficult, requiring in vitro test development. Basophils are likely to be involved in these reactions, and to evaluate the sensitivity, the specificity, and the predictive values of the histamine-release test, we performed a prospective study in 68 patients tested for suspected drug allergy. METHODS Positive diagnosis was established by history, skin tests, and, if needed, oral provocation tests. Histamine release in the presence of the drug was assessed on heparinized whole blood by enzyme immunoassay (Immunotech, France), and the cutoff value was set at 5% of total histamine content. Spontaneous and anti-IgE-induced histamine release was also studied in all subjects. RESULTS All patients presented to our clinic with reactions ranging from maculopapular exanthema to anaphylactic shock. Thirty-five patients had proven drug allergy; 33 were not allergic to drugs and served as a control group together with 40 other subjects with no history of drug allergy. Net histamine release was positive in 18/35 allergics and 27/73 nonallergics, giving poor sensitivity (51.4%), specificity (63.0%), and positive predictive value (29.3%), but valuable negative predictive value (81.1%). CONCLUSIONS The usefulness of the in vitro histamine-release test for the diagnosis of drug allergy appears to be insufficient.
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Affiliation(s)
- P Demoly
- Maladies Respiratoires, INSERM U454, CHU de Montpellier et Institut Universitaire de Recherche Clinique, France
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Moneret-Vautrin DA, Sainte-Laudy J, Kanny G, Frémont S. Human basophil activation measured by CD63 expression and LTC4 release in IgE-mediated food allergy. Ann Allergy Asthma Immunol 1999; 82:33-40. [PMID: 9988204 DOI: 10.1016/s1081-1206(10)62657-9] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND IgE-dependent basophil activation induced by an allergen elicit the release of LTC4 and the expression of the CD63 membrane marker. OBJECTIVE The aim of this study was to check if flow cytometric analysis of basophil activation could be applied to food allergy diagnosis and if this method paralleled LTC4 release. METHODS Patients were selected by the clinical history, skin tests, and provocation tests. Basophil activation induced by food extracts was studied in 24 control subjects and in 27 patients having a food allergy by LTC4 release test (LRT) and by flow cytometric anti-IgE+, CD63 + cell counting (BAT = basophil activation test). In case of negative anti-IgE response a passive blood donor basophil passive sensitization step was added to LRT and BAT. Leucocyte histamine release test was performed in 11 patients. RESULTS Basophil activation test was positive in 18/31 cases and LRT in 22/34 cases for food-allergic patients and, respectively, in 1/33 and 1/35 cases for the controls. A correlation was observed between specific IgE, BAT, and LRT. Basophil activation test and LRT performed after passive sensitization had an excellent sensitivity only for specific IgE levels ranging between 3.5 and 35 KU/L. CONCLUSION The present study shows that allergen-induced LTC4 release and anti-IgE, antiCD63 bicolor flow cytometric analysis of basophil activation may be used for food allergy diagnosis. Both tests have a good sensitivity and specificity. Basophil activation test and LRT are more efficient than histamine release test in case of high spontaneous histamine release, frequently observed in case of food allergy.
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Affiliation(s)
- D A Moneret-Vautrin
- Internal Medicine Department, Allergology and Clinical Immunology, Hôpital Central, Nancy, France
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Olszewski A, Pons L, Moutété F, Aimone-Gastin I, Kanny G, Moneret-Vautrin DA, Guéant JL. Isolation and characterization of proteic allergens in refined peanut oil. Clin Exp Allergy 1998; 28:850-9. [PMID: 9720819 DOI: 10.1046/j.1365-2222.1998.00325.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Allergic reactions to peanut oil are very much debated, even if the responsibility of peanut oil has been evoked in several cases of adverse reactions, including death related to severe asthma. The aim of the present study was to investigate the presence of allergenic proteins in peanut oil. Proteins were extracted from commercial refined peanut oil, with a relative content in the order of 0.1-0.2 microg per g of oil, and molecular sizes ranging from 14 up to 76kDa in SDS-PAGE. Eight protein bands were systematically observed in crude, neutralized and refined oils, with a molecular mass ranging from approximately 14 to 76 kDa, including one at 18 kDa which was identified by Western blot performed with serum from two allergic patients. The protein extract gave positive IgE-RIA with patient sera, positive in vitro leucocyte histamine release tests and positive skin-prick tests in allergic patients. The allergenic protein was purified by HPLC and [125I] iodide-labelled. It had an isoelectric point at 4.5 in isoelectrofocusing. In conclusion, we have demonstrated the presence of allergenic proteins in crude and refined peanut oil. These proteins are the same size as two allergens previously described in peanut protein extracts.
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Affiliation(s)
- A Olszewski
- Laboratory of Cellular and Molecular Biology in Nutrition, Faculty of Medicine, University H. Poincaré of Nancy, Vandoeuvre-les-Nancy, France
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Laxenaire MC. [Substances responsible for peranesthetic anaphylactic shock. A third French multicenter study (1992-94)]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1998; 15:1211-8. [PMID: 9636797 DOI: 10.1016/s0750-7658(97)85882-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since 1989, the epidemiological survey of anaphylactoid reactions occurring during anaesthesia is obtained in France with repeated inquiries by the Perioperative Anaphylactic Reactions Study Group. The members of this group collect during the study period the cases of patients having suffered from an anaphylactoid reaction and tested in their allergo-anaesthetic outpatient clinic, their characteristics (age, gender), the results of the allergological tests (mechanism, agents responsible for the reactions). The two previous surveys published in the Annales françaises d'anesthesie et de réanimation in 1990 and 1993 included 1,240 and 1,585 patients respectively. The current survey concerned 1,750 patients tested in 27 diagnostic centres, from January 1992 to June 1994. The reactions occurred at all ages, predominantly between 10 and 50 years, the sex-ratio (F/M) was 2.4. Allergological tests carried out to diagnose an immune mechanism for the shock were cutaneous tests in all centres (prick-tests in 21 centres, intradermal tests in 27 centres) using the same dilutions for the tested agents and the same threshold for positivity. Specific IgE antibodies against muscle relaxants, thiopentone and propofol, were measured by radio immunoassays in 20 centres. The leucocyte histamine release test was used in 10 centres. The immune origin of the shock--IgE dependent anaphylaxis--was diagnosed in 1,000 patients (57.8%) and due to 1,030 agents muscle relaxants (59.2%), latex (19%), hypnotics (5.9%), benzodiazepines (2.1%), opioids (3.5%), plasma substitutes (5%), antibiotics (3.1%) and other drugs given during anaesthesia such as aprotinine and protamine (2.2%). Suxamethonium was responsible for 39.3% of muscle relaxant anaphylaxis, vecuronium for 36%, atracurium for 14.5%, pancuronium for 4.8%, gallamine for 3.1% and alcuronium for 2.3%. The latter has been withdrawn from the French market in 1993. These differences in the incidence of reactions are correlated with the clinical use of muscle relaxants in France for vecuronium and atracurium, however not for suxamethonium, responsible for 39% of the reactions but representing only 5% of the muscle relaxants sold in France. The comparison with the two previous surveys confirms that the mechanism of more than half of the anaphylactoid reactions occurring during anaesthesia is of immune origin, due to specific IgE antibodies. It is therefore essential to systematically carry out an allergologic assessment several weeks after the reaction, in order to discard for the subsequent anaesthetics the agent(s) responsible for anaphylaxis. If the muscle relaxants remain the first drugs involved in shock occurring at induction, there is a significant increase in latex shock, as demonstrated by the three epidemiological surveys (0.5%, 12.5% and now 19%). The incidence of other anaesthetic agents, antibiotics and plasma substitutes remains unchanged.
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Affiliation(s)
- M C Laxenaire
- Département d'anesthésie-réanimation, CHU hôpital central, Nancy, France
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Kanny G, de Hauteclocque C, Moneret-Vautrin DA. Food anaphylaxis to bovine serum albumin. J Allergy Clin Immunol 1998; 101:137-9. [PMID: 9449518 DOI: 10.1016/s0091-6749(98)70210-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- G Kanny
- Service de Médecine D, Médecine Interne, Centre Hospitalier Universitaire de Nancy, Hôpital Central, France
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Moneret-Vautrin DA. Crossreactions to muscle relaxants in the operating room. Clin Rev Allergy Immunol 1997; 15:471-6. [PMID: 9484583 DOI: 10.1007/bf02737741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- D A Moneret-Vautrin
- Department of Clinical Immunology and Allergology, University Hospital, Nancy, France
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Kanny G, Hauteclocque C, Moneret-Vautrin DA. Sesame seed and sesame seed oil contain masked allergens of growing importance. Allergy 1996. [DOI: 10.1111/j.1398-9995.1996.tb04500.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guéant JL, Mata E, Namour F, Romano A, Aimone-Gastin I, Kanny G, Moneiet-Vautrin D, Laxenaire MC. Criteria of evaluation and of interpretation of Sepharose drug IgE-RIA to anaesthetic drugs. Allergy 1996. [DOI: 10.1111/j.1398-9995.1996.tb04743.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kanny G, Hauteclocque C, Moneret-Vautrin DA. Sesame seed and sesame seed oil contain masked allergens of growing importance. Allergy 1996. [DOI: 10.1111/j.1398-9995.1996.tb02141.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Guéant J, Moutété F, Olszewski A, Pons L, Gastin I, Moneret-Vautrin D. Allergie à l'arachide et à l'huile d'arachide. ACTA ACUST UNITED AC 1995. [DOI: 10.1016/s0335-7457(05)80521-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kanny G, Fremont S, Nicolas JP, Moneret-Vautrin DA. Food allergy to sunflower oil in a patient sensitized to mugwort pollen. Allergy 1994; 49:561-4. [PMID: 7825724 DOI: 10.1111/j.1398-9995.1994.tb01129.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- G Kanny
- Service de Médecine, Centre Hospitalier Universitaire de Nancy, Hôpitaux de Brabois, Vandoeuvre-les Nancy, France
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Mata E, Favier C, Moneret-Vautrin DA, Nicolas JP, Han Ching L, Guéant JL. Surimi and native codfish contain a common allergen identified as a 63-kDa protein. Allergy 1994; 49:442-7. [PMID: 7521143 DOI: 10.1111/j.1398-9995.1994.tb00837.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We have compared the allergenicity of codfish and surimi (prepared from codfish) by skin testing, specific IgE-RIA, and leukocyte histamine release (LHR) in six fish-allergic patients. Prick tests were positive for codfish and, to a lesser extent, surimi. The percentages of labeled anti-IgE bound to surimi-Sepharose were 1.55 +/- 0.19% and 3-6% with control and patient sera, respectively. Inhibition of the surimi protein-Sepharose IgE-RIA was greatest (80%) at protein concentrations of 13.4 and 408.5 micrograms/ml for codfish and surimi extract, respectively. The allergenic protein was isolated by gel filtration and subjected to SDS-PAGE. The eluate from codfish contained several proteins ranging from 13 to 63 kDa, while the eluate from surimi contained a single 63-kDa protein. It was concluded that surimi contained a single allergenic protein.
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Affiliation(s)
- E Mata
- Laboratoire de Biochimie Nutritionnelle, INSERM U 308, Faculté de Médicine de Nancy, France
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Laxenaire MC. Drugs and other agents involved in anaphylactic shock occurring during anaesthesia. A French multicenter epidemiological inquiry. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1993; 12:91-6. [PMID: 8368591 DOI: 10.1016/s0750-7658(05)81015-9] [Citation(s) in RCA: 123] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
An epidemiological inquiry was carried out in departments of anaesthesia and immunology in French University and General Hospitals, as well as among those who were already known to have an allergo-anaesthesia outpatient clinic. This inquiry aimed to find out how many patients had undergone diagnostic investigations after as well as an anaphylactoid reaction during an anaesthetic in 1990 and 1991, as well as the demographic data, the kind of assessment, the accident mechanism and the drugs involved. Twenty-one French centres replied to the questionnaire and a series of 1,585 patients tested over a two-year period was thus collected. There were three female patients to one male. The reactions occurred mostly in the adult (80%), but 9% were observed in children. Allergological tests for IgE-dependent anaphylaxis were the skin tests (21 centres), combined with radioimmunological assays of specific serum antibodies to muscle relaxants (10 centres), propofol (9 centres), latex (5 centres), leukocyte histamine release (9 centres) and human basophil degranulation test (4 centres). The criteria for a positive result were the same for all centres. Among these 1,585 patients, 813 were recognized as having had a reaction of immunological origin (52%). The substances involved were identified in these 813 patients as being muscle relaxants (70%), latex (12.6%), hypnotics (3.6%), benzodiazepines (2.0%), opioids (1.7%), colloids (4.7%), and antibiotics (2.6%). Suxamethonium was responsible for 43% of the IgE-dependent reactions involving a muscle relaxant, vecuronium for 37%, pancuronium for 13%, alcuronium for 7.6%, atracurium for 6.8% and gallamine for 5.6%.(ABSTRACT TRUNCATED AT 250 WORDS)
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Moneret-Vautrin DA, Motin J, Mata E, Guéant JL, Kanny G, Widmer S, Laxenaire MC. Preventing muscle relaxant anaphylaxis with monovalent haptens. A preliminary study. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1993; 12:190-202. [PMID: 7690205 DOI: 10.1016/s0750-7658(05)81030-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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