Assessing cross-reactivity to neuromuscular blocking agents by skin and basophil activation tests in patients with neuromuscular blocking agent anaphylaxis
| Autor: | Jamma Li, Suran L. Fernando, Sarah Green, Benedict A. Krupowicz, Oliver Giles Best, Richard B. Fulton, Marc J. Capon, Michael Rose |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Allergy Adolescent Provocation test Cross Reactions medicine.disease_cause Drug Hypersensitivity Young Adult Allergen Humans Medicine Clinical significance Rocuronium Anaphylaxis Aged Skin Tests business.industry Australia Middle Aged medicine.disease Neuromuscular Blocking Agents Basophils Basophil activation Anesthesiology and Pain Medicine Anesthesia Female business medicine.drug |
| Zdroj: | British Journal of Anaesthesia. 123:e144-e150 |
| ISSN: | 0007-0912 |
| Popis: | Background Following diagnosis of neuromuscular blocking agent (NMBA) anaphylaxis, identifying safe alternatives for subsequent anaesthesia is critical. A patient with anaphylaxis to one NMBA can also have an allergic reaction to other NMBAs (cross-reactivity). Whilst drug provocation testing is standard for identifying or excluding allergy, there is significant risk. In vitro, after an allergen activates basophils, basophils express surface activation markers that can be measured by basophil activation testing (BAT). We compared cross-reactivity between NMBAs assessed by BAT against that by skin testing. Methods All patients attending an anaesthetic allergy clinic in Sydney, Australia between May 2017 and July 2018 diagnosed with NMBA anaphylaxis qualified for this study comparing intradermal skin tests and BAT with a panel of NMBAs (rocuronium, vecuronium, pancuronium, suxamethonium, cisatracurium). Results Of the 61 patients participating, sensitisation on skin testing and on BAT completely matched in only nine patients (15%). Sensitisation was not in agreement for pancuronium, cisatracurium and rocuronium, but was in agreement for vecuronium and suxamethonium. Nine patients with negative skin tests subsequently tolerated cisatracurium, and one false positive on BAT to cisatracurium was detected. Conclusions The utility of BAT in identifying safe NMBAs for subsequent anaesthesia needs further evaluation. BAT detects a different cross-reactivity profile to skin tests. Negative skin testing and BAT might increase confidence in performing drug provocation testing, but this and follow-up of subsequent anaesthesia in our cohort is necessary to determine the clinical significance of BAT sensitisation. |
| Databáze: | OpenAIRE |
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