Department of Anaesthesia, Royal North Shore Hospital, Sydney, NSW, Australia.
University of Sydney, Sydney, NSW, Australia.
Acta Anaesthesiol Scand. 2018 May;62(5):628-634. doi: 10.1111/aas.13077. Epub 2018 Jan 24.
Investigation of immediate hypersensitivity reactions in the perioperative setting involves skin testing and measurement of specific IgE (sIgE) as standard practice. In the case of the neuromuscular blocking agents (NMBAs), the main allergenic epitopes have been shown to be substituted ammonium groups. Commercial assays are available for detection of sIgE to these epitopes using morphine and pholcodine substrates but questions have been raised about the effectiveness of these assays in the diagnosis of benzylisoquinoline anaphylaxis. This study was therefore undertaken to assess the effectiveness of these assays in the diagnosis of hypersensitivity reactions to this group of NMBAs.
Analysis was carried out on all available results for patients assessed at the Royal North Shore Hospital Anaesthetic Allergy Clinic during the period June 2009 to June 2016. Standardised intradermal skin tests were performed with a panel of NMBAs. Measurement of sIgE to morphine and pholcodine was performed via the Phadia ImmunoCAP system.
For all patients with positive skin test results to NMBAs which included a benzylisoquinoline NMBA (n = 24), 75% exhibited negative sIgE to both morphine and pholcodine. Where patients were reactive to benzylisoquinoline NMBAs alone (n = 12), 100% exhibited negative sIgE results, indicating 0% sensitivity of the assays relative to skin testing, in this subgroup.
Use of sIgE testing to morphine and pholcodine in the assessment of NMBA immediate hypersensitivity is a valuable tool particularly in the case of reactions to the aminosteroid NMBAs. However, these assays are unreliable in detecting sensitisation to benzylisoquinoline NMBAs.
围手术期速发型过敏反应的研究包括皮肤测试和特异性 IgE（sIgE）的测量，这是标准做法。在神经肌肉阻滞剂（NMBAs）的情况下，已显示主要的过敏原表位是取代的铵基团。商业检测试剂盒可用于检测吗啡和 pholcodine 底物上针对这些表位的 sIgE，但人们对这些检测试剂盒在诊断苯异喹啉类过敏中的有效性提出了质疑。因此，本研究旨在评估这些检测试剂盒在诊断此类 NMBAs 过敏反应中的有效性。
对 2009 年 6 月至 2016 年 6 月在皇家北岸医院麻醉过敏诊所评估的所有患者的可用结果进行了分析。使用 NMBAs 进行了标准化皮内皮肤测试。通过 Phadia ImmunoCAP 系统测量吗啡和 pholcodine 的 sIgE。
所有对包括苯异喹啉 NMBA 的 NMBAs 皮肤测试结果呈阳性的患者（n=24）中，有 75%对吗啡和 pholcodine 的 sIgE 呈阴性。在仅对苯异喹啉类 NMBAs 有反应的患者（n=12）中，100%对 sIgE 结果呈阴性，表明相对于皮肤测试，这些检测试剂盒的敏感性为 0%，在该亚组中。
在评估 NMBA 速发型过敏反应时，使用吗啡和 pholcodine 的 sIgE 检测是一种有价值的工具，特别是在对氨基甾体 NMBAs 反应的情况下。然而，这些检测试剂盒在检测对苯异喹啉类 NMBAs 的致敏性方面不可靠。
