De Weck A L, Sanz M L, Gamboa P M, Aberer W, Blanca M, Correia S, Erdman S, Jermann J M, Kanny G, Kowalski M, Mayorga L, Medrala W, Merk A, Sturm G J, Sainte-Laudy J, Schneider M S, Sczczeklik A, Weber J M, Wedi A
Department of Allergology and Clinical Immunology, Clinica Universidad de Navarra, Collaborative center of Pamplona, Spain.
J Investig Allergol Clin Immunol. 2009;19(5):355-69.
We present the results obtained from the largest series of in vitro diagnostic tests ever reported in patients with clinically validated hypersensitivity to acetylsalicylic acid (ASA)/nonsteroidal anti-inflammatory drugs (NSAID) compared with various categories of controls tolerating ASA/NSAIDs. This multicenter study, which was performed within the framework of the European Network for Drug Allergy (ENDA) group, showed that the basophil activation test (BAT), particularly when used with the 3 NSAIDs aspirin (ASA), diclofenac (DIC), and naproxen (NAP), allows us to confirm the diagnosis of NSAID hypersensitivity syndrome. The results of the cellular allergen stimulation test (CAST) frequently correlate with those of the BAT, although not always. An unexpected finding was that basophil activation by NSAIDs is not an all-or-nothing phenomenon restricted to clinically hypersensitive patients, but that it also occurs in a dose-related manner in some NSAID-tolerant control individuals.Therefore, NSAID hypersensitivity appears as a shift in the normal pharmacological response to NSAIDs. These findings allow us to formulate a new rational hypothesis about the mechanism of NSAID hypersensitivity syndrome, a mechanism that most authors continue to describe as "unknown."
We enrolled 152 patients with a history of hypersensitivity to NSAIDs and 136 control participants in 11 different centers between spring 2003 and spring 2006. Flowcytometric BAT was performed.
The most noteworthy results of our study were that 57% of 140 patients presented very clear-cut positive BAT results to multiple NSAIDs, and 16% were entirely negative. In about 27% of cases, positive results were obtained with 1 or 2 concentrations of a single NSAID. There is clearly a correlation between the results of BAT and CAST.
BAT seems particularly indicated in patients with a clinical history of NSAID intolerance, and in whom a provocation test is not advisable for ethical, clinical, or other reasons. Clear-cut positive results can be considered as confirming a history of NSAID hypersensitivity, although negative results may not exclude it.
我们展示了在临床确诊对乙酰水杨酸（ASA）/非甾体抗炎药（NSAID）过敏的患者中进行的最大规模体外诊断试验系列所获得的结果，并与耐受ASA/NSAIDs的各类对照进行比较。这项在欧洲药物过敏网络（ENDA）组框架内开展的多中心研究表明，嗜碱性粒细胞活化试验（BAT），特别是与三种NSAIDs阿司匹林（ASA）、双氯芬酸（DIC）和萘普生（NAP）联合使用时，能够确诊NSAID过敏综合征。细胞变应原刺激试验（CAST）的结果虽不总是与BAT结果相关，但经常与之相关。一个意外发现是，NSAIDs引起的嗜碱性粒细胞活化并非仅限于临床过敏患者的全或无现象，在一些耐受NSAID的对照个体中也以剂量相关的方式发生。因此，NSAID过敏表现为对NSAIDs正常药理反应的一种转变。这些发现使我们能够对NSAID过敏综合征的机制提出一个新的合理假设，而大多数作者仍继续将该机制描述为“未知”。
在2003年春季至2006年春季期间，我们在11个不同中心招募了152例有NSAIDs过敏史的患者和136名对照参与者。进行了流式细胞术BAT。
我们研究中最值得注意的结果是，140例患者中有57%对多种NSAIDs呈现非常明确的阳性BAT结果，16%完全为阴性。在约27%的病例中，使用单一NSAID的1或2个浓度获得了阳性结果。BAT和CAST的结果之间显然存在相关性。
BAT似乎特别适用于有NSAID不耐受临床病史且因伦理、临床或其他原因不宜进行激发试验的患者。明确的阳性结果可被视为证实了NSAID过敏史，尽管阴性结果可能无法排除该过敏史。
