Ebo D G, Piel G C, Conraads V, Stevens W J
Department of Immunology, Allergology and Rheumatology, University of Antwerp, Belgium.
Ann Allergy Asthma Immunol. 2001 Sep;87(3):243-5. doi: 10.1016/S1081-1206(10)62234-X.
Intravenous administration of cyclosporine, which contains Cremophor EL (a polyethoxylated castor oil; BASF, Berlin, Germany), has occasionally resulted in an anaphylactic reaction. An apparent hypersensitivity reaction (bronchospasm and decrease in blood pressure) had occurred during heart transplantation in a 59-year-old woman after intravenous infusion of cyclosporine. Subsequent oral administration of cyclosporine precipitated no reaction.
The purpose of this study was to attempt to ascertain the mechanism responsible for the anaphylactic reaction.
Hypersensitivity investigations, including total serum IgE and allergen-specific IgE quantifications, skin testing, and basophil activation tests by flow cytometric determination of CD63 upregulation were undertaken in the study patient and in two healthy control subjects who were free of medication.
The results of intradermal testing with Cremophor EL were positive after 15 minutes in the study patient only. Both cyclosporine and Cremophor EL induced considerable activation of the basophils from our study patient, with an upregulation of CD63 expression from 1% to 39% and 55%, respectively. In contrast, the expression of CD63 on basophils from the two control subjects remained essentially unchanged.
The negative investigative findings in the control subjects, the patient's clinical manifestations in temporal relationship to the infusion, her positive results on intradermal testing with Cremophor, the basophil activation test results, and her uneventful course after oral administration of cyclosporine strongly support the presence of IgE antibodies to Cremophor EL in our patient.
静脉注射含聚氧乙烯蓖麻油（Cremophor EL，德国柏林巴斯夫公司生产）的环孢素偶尔会引发过敏反应。一名59岁女性在心脏移植术中静脉输注环孢素后出现明显的过敏反应（支气管痉挛和血压下降）。随后口服环孢素未引发反应。
本研究旨在确定过敏反应的机制。
对该研究患者以及两名未服用药物的健康对照者进行了超敏反应检查，包括总血清IgE和过敏原特异性IgE定量、皮肤试验以及通过流式细胞术测定CD63上调来进行嗜碱性粒细胞活化试验。
仅在研究患者中，皮内注射Cremophor EL后15分钟结果呈阳性。环孢素和Cremophor EL均使研究患者的嗜碱性粒细胞大量活化，CD63表达分别从1%上调至39%和55%。相比之下，两名对照者嗜碱性粒细胞上CD63的表达基本未变。
对照者的阴性检查结果、患者与输注时间相关的临床表现、她对Cremophor皮内试验的阳性结果、嗜碱性粒细胞活化试验结果以及她口服环孢素后的平稳病程，有力地支持了我们的患者体内存在针对Cremophor EL的IgE抗体。
