scholarly journals Evaluation of a New Routine Diagnostic Test for Immunoglobulin E Sensitization to Neuromuscular Blocking Agents

2011 ◽  
Vol 114 (1) ◽  
pp. 91-97 ◽  
Author(s):  
Dominique Laroche ◽  
Sylvie Chollet-Martin ◽  
Pierre Léturgie ◽  
Laure Malzac ◽  
Marie-Claude Vergnaud ◽  
...  
Keyword(s):  
Skin Test ◽  
Quaternary Ammonium ◽  
Immunoglobulin E ◽  
Solid Phase ◽  
Specific Ige ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Immediate Hypersensitivity

Background Neuromuscular blocking agents (NMBA) are responsible for most immediate hypersensitivity reactions during anesthesia, as a result of the presence of a quaternary ammonium ion. The aim of this study was to evaluate the diagnostic performance of a commercial immunoglobulin E (IgE) test (quaternary ammonium morphine [QAM]) for diagnosing sensitivity to NMBA. Methods We tested 168 patients exposed to NMBAs during anesthesia. Of those patients, 54 had an uneventful procedure and 114 had immediate hypersensitivity reactions, and 57 patients had positive skin tests to the administered NMBA, whereas 57 had negative skin tests. Specific IgE concentrations determined with the QAM method based on a morphine solid phase were compared with those obtained with a recommended experimental method with a choline solid phase. Results For the QAM test, a 0.35 kUA/l positivity cutoff was chosen from the receiver operating characteristics curve. QAM-specific IgE was found in 84.2% of skin test-positive reactors (80.7% with the recommended method; no significant difference), and binding was inhibited by the culprit NMBA in 80% of cases. The frequency of QAM-specific IgE positivity was significantly higher in skin test-negative reactors (24.6%) than in controls (9.3%), suggesting NMBA sensitivity. Conclusion Sensitivity of the QAM test (84.2%), together with its simplicity and suitability for routine laboratory use, makes it a valuable tool, in conjunction with skin tests, for diagnosing NMBA sensitivity in patients who react after NMBA injection. The QAM test is of particular interest when skin tests are not available or not reliable or give results poorly compatible with mediator release or clinical features.

scholarly journals Assessment of immediate and non-immediate hypersensitivity contrast reactions by skin tests and provocation tests: A review

2021 ◽  
Vol 35 ◽  
pp. 205873842110150
Author(s):  
Rakesh D Bansie ◽  
A Faiz Karim ◽  
Maurits S van Maaren ◽  
Maud AW Hermans ◽  
Paul LA van Daele ◽  
...  
Keyword(s):  
Contrast Media ◽  
Skin Test ◽  
Positive Skin Test ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Immediate Hypersensitivity ◽  
Positive Skin ◽  
Provocation Tests ◽  
Iodinated Contrast ◽  
Negative Skin Test

Introduction: Allergic and nonallergic hypersensitivity reactions to iodinated contrast media (ICM) and gadolinium-based contrast media are classified as immediate or non-immediate hypersensitivity reactions (IHR and NIHR), respectively. Skin tests and provocation tests are recommended for the evaluation of hypersensitivity reactions to contrast agents; however provocations are not common in clinical practice. Methods: A MEDLINE search was conducted to investigate studies comprising both skin tests and provocation tests that evaluated hypersensitivity reactions to ICM. Results: Nineteen studies were identified that reported on skin tests, followed by provocations. In the case of IHR to ICM, 65/69 (94%) patients with a positive skin test for the culprit media tolerated a challenge with a skin-test-negative alternative ICM. In IHR to ICM with a negative skin test for the culprit media, provocations were positive in 3.2%–9.1% patients. In the case of a NIHR to ICM with a positive skin test, provocation with a skin-test-negative agent was tolerated in 75/105 (71%) of cases. In NIHR with a negative skin test for the culprit agent, re-exposure to the culprit or an alternative was positive in 0%–34.6% patients. Provocations with the same ICM in skin test positive patients with IHR or NIHR were positive for a majority of the patients, although such provocation tests were rarely performed. Data on hypersensitivity reactions, skin tests and provocations with gadolinium-based contrast media were limited; however, they exhibited a pattern similar to that observed in ICM. Conclusion: In both ICM and gadolinium-based contrast media, the risk of an immediate repeat reaction is low when skin tests are negative. In contrast, a provocation with a skin-test-positive contrast medium showed a high risk of an immediate repeat hypersensitivity reaction. Therefore, a thorough medical history is necessary, followed by skin tests. A provocation is recommended, for diagnostic work-up, when the diagnosis is uncertain.

The Study of IgE in the Diagnosis of Allergic Disorders in an Otolaryngology Practice

1979 ◽  
Vol 87 (3) ◽  
pp. 351-358 ◽  
Author(s):  
Donald J. Nalebuff ◽  
Richard G. Fadal ◽  
Majid Ali
Keyword(s):  
Skin Test ◽  
Allergic Disease ◽  
Specific Ige ◽  
In Vitro Assays ◽  
Hypersensitivity Reactions ◽  
Immediate Hypersensitivity ◽  
Reaginic Antibody ◽  
Clinically Significant ◽  
Allergic Disorders

Within months after the identification of IgE as the reaginic antibody and principal trigger of immediate hypersensitivity reactions, several radioimmunoassays were developed for its detection in serum. Observations and results obtained with the use of two commercially available in vitro assays in the screening diagnosis of inhalant allergic disease are reported. Over 80% of suspected atopic patients tested had detectable specific IgE to at least two allergens. Both total and specific IgE determinations served useful roles in the recognition of clinically significant allergic disease. Results obtained with these procedures correlate well with information previously obtained only by skin test endpoint titration.

scholarly journals Immunoglobulin E Antibodies to Rocuronium

2007 ◽  
Vol 107 (2) ◽  
pp. 253-259 ◽  
Author(s):  
Didier G. Ebo ◽  
Lennart Venemalm ◽  
Chris H. Bridts ◽  
Frederik Degerbeck ◽  
Hans Hagberg ◽  
...  
Keyword(s):  
Immunoglobulin E ◽  
Cross Reactivity ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Skin Tests ◽  
Decision Threshold ◽  
Reliable Technique ◽  
Total Ige ◽  
Blocking Agents ◽  
And Control

Background Diagnosis of allergy from neuromuscular blocking agents is not always straightforward. The objectives of the current study were to investigate the value of quantification of immunoglobulin E (IgE) by ImmunoCAP (Phadia AB, Uppsala, Sweden) in the diagnosis of rocuronium allergy and to study whether IgE inhibition tests can predict clinical cross-reactivity between neuromuscular blocking agents. Methods Twenty-five rocuronium-allergic patients and 30 control individuals exposed to rocuronium during uneventful anesthesia were included. Thirty-two sera (total IgE > 1,500 kU/l) were analyzed for potential interference of elevated total IgE titers. Results were compared with quantification of IgE for suxamethonium, morphine, and pholcodine. Cross-reactivity between drugs was assessed by IgE inhibition and skin tests. Results Sensitivity of IgE for rocuronium, suxamethonium, morphine, and pholcodine was 68, 60, 88, and 86%, respectively. Specificity was 100% for suxamethonium, morphine, and pholcodine IgE and 93% for rocuronium IgE. ROC analysis between patients and control individuals changed the threshold to 0.13 kUa/l for rocuronium, 0.11 kUa/l for suxamethonium, 0.36 kUa/l for morphine, and 0.43 kUa/l for pholcodine. Corresponding sensitivity was 92, 72, 88, and 86%, respectively. Specificity was unaltered. Interference of elevated total IgE with quantification of IgE was demonstrated by the analysis in sera with a total IgE greater than 1,500 kU/l. IgE inhibition did not predict clinical relevant cross-reactivity. Conclusions The rocuronium ImmunoCAP constitutes a reliable technique to diagnose rocuronium allergy, provided an assay-specific decision threshold is applied. IgE assays based on compounds bearing ammonium epitopes are confirmed to represent reliable tools to diagnose rocuronium allergy. High total IgE titers were observed to affect specificity of the assays.

Anaphylaxis during Anesthesia in Norway

2005 ◽  
Vol 102 (5) ◽  
pp. 897-903 ◽  
Author(s):  
Torkel Harboe ◽  
Anne Berit Guttormsen ◽  
Aagot Irgens ◽  
Turid Dybendal ◽  
Erik Florvaag
Keyword(s):  
General Anesthesia ◽  
Network Formation ◽  
Immunoglobulin E ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Skin Tests ◽  
Blocking Agents ◽  
High Prevalence ◽  
Special Concern

Background Several studies have recognized neuromuscular blocking agents as the most common cause of anaphylaxis during general anesthesia, but the reported frequencies vary considerably between countries. In Norway, the issue has raised special concern because of reports from the Norwegian Medicines Agency that suggest a high prevalence. This article presents the results from a standardized allergy follow-up examination of 83 anaphylactic reactions related to general anesthesia performed at one allergy center in Bergen, Norway. Methods Eighty-three cases were examined during the 6-yr period of 1996-2001. The diagnostic protocol consisted of case history, serum tryptase measurements, specific immunoassays, and skin tests. Results Immunoglobulin E-mediated anaphylaxis was established in 71.1% of the cases, and neuromuscular blocking agents were by far the most frequent allergen (93.2%). Suxamethonium was the most frequently involved substance, followed by rocuronium and vecuronium. The few reactions in which other allergies could be detected were mainly linked to latex (3.6%). Conclusions Neuromuscular blocking agents were the dominating antigens causing immunoglobulin E-mediated anaphylaxis in this study. The data could not be used for estimation of the incidence of allergy toward neuromuscular blocking agents in Norway. Larger patient samples, standardization of reporting, and diagnostic protocols should be pursued by network formation to produce data more suitable for epidemiologic research.

scholarly journals Diagnostic Value of Skin Tests and Serum Specific IgE in the Diagnosis of Immediate Hypersensitivity Reactions to Platins

2015 ◽  
Vol 135 (2) ◽  
pp. AB386
Author(s):  
Natalia I. Pérez Sánchez ◽  
Leticia Sánchez-Morillas ◽  
María Rubio-Pérez ◽  
Mercedes Cimarra ◽  
María Luisa González ◽  
...  
Keyword(s):  
Specific Ige ◽  
Diagnostic Value ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Immediate Hypersensitivity

scholarly journals Review of Procedures for Investigation of Anaesthesia-Associated Anaphylaxis in Newcastle, Australia

2008 ◽  
Vol 36 (2) ◽  
pp. 201-207 ◽  
Author(s):  
O. Mcneill ◽  
R. K. kerridge ◽  
M. J. Boyle
Keyword(s):  
Skin Testing ◽  
Elevated Serum ◽  
Specific Ige ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Acute Episode ◽  
Serum Tryptase ◽  
Common Cause ◽  
Blocking Agents ◽  
Second Procedure

The procedures, results and outcomes of investigation of 50 patients with clinical episodes of anaesthesia-associated anaphylaxis were retrospectively reviewed. Assessment was performed by measurement of serum tryptase and specific IgE and a combination of skin prick and intradermal skin testing. Testing was performed both for agents received during the anaesthetic and for agents the patient may encounter in future procedures. Twenty of 50 patients underwent a subsequent procedure after assessment. Sensitisation to neuromuscular blocking agents was identified in 18 patients (36%). Sensitisation to propofol (14 patients; 28%) and latex (four patients; 8%) was also frequently identified. No precise cause was identified in 11 cases (22%). Reactivity to more than one agent was identified in 14 patients (28%). Serum tryptase was measured within six hours of the episode in only 28 of the 50 cases. All the patients with elevated serum tryptase had clinically severe reactions. One patient initially found to be sensitised to propofol had another reaction during a second procedure, prompting further assessment where chlorhexidine reactivity was identified. Subsequent surgery in that patient and in 19 other patients where agents implicated in the testing were avoided, proceeded without incident. The results reaffirm that neuromuscular blocking agents are the most common cause of anaphylaxis during anaesthesia. The importance of serum tryptase measurement at the time of the acute episode needs to be emphasised. Investigation should include screening for chlorhexidine and latex in all patients, as exposure to both these agents is common and may be overlooked.

Neue Charakteristika klinisch manifester Latexallergiker

2019 ◽  
Vol 7 (1) ◽  
pp. 29-31
Author(s):  
Vera Mahler
Keyword(s):  
Medical History ◽  
Skin Test ◽  
Correct Diagnosis ◽  
Natural Rubber Latex ◽  
Specific Ige ◽  
Latex Allergy ◽  
Skin Tests ◽  
Diagnostic Challenge ◽  
Positive Skin ◽  
Significant Difference

Background: Natural rubber latex (NRL) allergy is commonly diagnosed according to medical history, skin allergy tests, and serological analyses. However, skin tests are increasingly being abandoned because of (i) their time-consuming nature, (ii) latex preparations for skin tests being not commercially available, and (iii) the use of in-house prepared test solutions is becoming ever more difficult due to increasing regulatory hurdles. In this light, we have evaluated differences in the profiles of current and former patients with suspected latex allergy. Methods: Sera of skin test-positive patients from a historic cohort (1995-2001, n = 149 patients) and currently (2014-2015, n = 48 patients) were simultaneously analyzed for specific IgE to latex by ImmunoCAP. If the serological screening was positive (≥ 0.35 kU/l), component-resolved diagnostics including profilins and cross-reactive carbohydrate determinants (CCDs) were performed. Results: In contrast to 88% (131/149) of the skin test-positive patients from the 1990s, only 51.1% (24/47) of the current cohort were found positive for specific IgE to latex. While 48.3% (72/149) of the patients had a convincing positive history in the 1990s, current skin test-positive patients rarely reported a relevant medical history (8.5%, 4/47). Specific IgE levels to latex were significantly higher in former patients with suspected latex allergy (p < 0.001) than in former sensitized individuals without allergy. However, this significant difference was lost in current allergic and sensitized patients with positive skin tests. Conclusion: Sensitization profiles in patients with latex allergy have changed significantly over the last 2 decades. Discrimination between NRL sensitization and clinical allergy remains a diagnostic challenge. Our data highlight the need for a combination of all 3 criteria, i.e., patient history, skin test, and analysis of specific IgE, for a correct diagnosis of latex allergy.

In Vivo Cysteinyl Leukotriene Release in Allergic and Nonallergic Immediate Hypersensitivity Reactions during Anesthesia

2017 ◽  
Vol 126 (5) ◽  
pp. 834-841 ◽  
Author(s):  
Dominique Laroche ◽  
Pierre Léturgie ◽  
Delphine Mariotte ◽  
Yann Ollivier ◽  
Jean-Luc Hanouz ◽  
...  
Keyword(s):  
Mast Cell ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Immediate Hypersensitivity ◽  
Mast Cell Tryptase ◽  
Cysteinyl Leukotriene ◽  
Negative Results ◽  
Important Mediator ◽  
The Difference

Abstract Background Immediate hypersensitivity reactions occurring during anesthesia are classified as allergic when skin tests and mast cell tryptase are positive and as nonallergic when negative results are obtained. Cysteinyl leukotrienes (cysLTs) are potent mediators synthesized by mast cell and eosinophil that induce bronchial constriction. They could play a role in hypersensitivity reactions. Methods cysLT C4, D4, and E4 concentrations were measured by a competition immunoassay in serial plasma samples obtained prospectively from 21 anesthetized controls and retrospectively from 34 patients who reacted at induction of anesthesia (24 with allergic and 10 with nonallergic reactions). Results In controls, the median (interquartile range) cysLT concentration was 0.83 (0.69 to 1.02) μg/l before anesthesia and was unchanged 30 min, 6 h, and 24 h afterward. In the patients with allergic reactions, the values were highly increased 30 to 60 min after the reaction (17.9 [7.8 to 36.0] μg/l), while the patients with nonallergic reactions had less increased values (7.3 [3.0 to 11.5] μg/l). The difference between the three groups was significant (P &lt; 0.0001). Increased values persisted during the 24 h of observation. Concentrations were significantly higher in patients with bronchospasm (P = 0.016). Conclusions cysLTs appear to be an important mediator of allergic and nonallergic immediate hypersensitivity reactions. These findings might open a new field for management of patients with hypersensitivity reactions, especially nonallergic ones.

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