Department of Anesthesiology and Critical Care Medicine, Paris-Seine-Saint-Denis Hospital Group, APHP, Paris, France & Paris 13 University, Sorbonne-Paris-Cité, Paris, France.
Immunology Department, Bichat Hospital, APHP, Paris, France; UMR-996 INSERM, Paris-Sud University, Châtenay-Malabry, France.
J Allergy Clin Immunol Pract. 2018 Sep-Oct;6(5):1681-1689. doi: 10.1016/j.jaip.2017.12.037. Epub 2018 Feb 22.
Neuromuscular blocking agents (NMBAs) are the main agents involved during perioperative immediate hypersensitivity. The etiological diagnosis (IgE-mediated allergy vs nonallergy) is linked to the clinical presentation together with tryptase and histamine levels and skin test results. The role of basophil activation test (BAT) needs to be better defined in this setting.
To assess the role of BAT compared with the results of skin testing in 31 patients experiencing immediate NMBA hypersensitivity and compare skin test results and BAT performances in the identification of alternative NMBAs.
Histamine and tryptase levels were quantified. Anesthetic drugs, including NMBAs, were skin-tested. Basophil CD63 and CD203c expressions were measured in response to serial dilutions of the different NMBAs.
Allergy and Nonallergy groups involved 19 and 12 patients, respectively. Circulating histamine and tryptase levels were significantly increased in allergic patients. In the Allergy group, while skin test results were positive in 100% (19 of 19) of the cases, BAT positivity to the culprit NMBA reached 78.9% (15 of 19) when combining CD63 and CD203c. NMBAs cross-reactivity was identified through skin testing and BAT in 36.8% (7 of 19) and 26.3% (5 of 19) of the cases, respectively. The concordance (culprit and cross-reactive NMBAs) between skin tests and BATs was between 73.6% (14 of 19) and 100% (19 of 19) for each NMBA. Negative skin-tested NMBAs were uneventfully used in 7 NMBA-allergic patients. In the Nonallergy group, skin test results were negative in 100% of the cases while BAT result was positive once (CD63 upregulation).
In our technical conditions, BAT does not replace skin testing in the assessment of NMBA allergy.
神经肌肉阻滞剂（NMBAs）是围手术期即刻过敏反应的主要药物。病因诊断（IgE 介导的过敏与非过敏）与临床症状、类胰蛋白酶和组胺水平以及皮肤试验结果有关。嗜碱性粒细胞激活试验（BAT）在这种情况下的作用需要进一步明确。
评估 BAT 与 31 例即刻 NMBA 过敏患者皮肤试验结果的相关性，并比较皮肤试验和 BAT 在识别替代 NMBAs 方面的性能。
定量检测组胺和类胰蛋白酶水平。对麻醉药物（包括 NMBAs）进行皮肤试验。用不同 NMBA 的系列稀释液测量嗜碱性粒细胞 CD63 和 CD203c 的表达。
过敏组和非过敏组分别有 19 例和 12 例患者。过敏患者的循环组胺和类胰蛋白酶水平显著升高。在过敏组中，19 例患者中皮肤试验结果均为阳性（19/19），而当同时结合 CD63 和 CD203c 时，BAT 对罪魁祸首 NMBA 的阳性率为 78.9%（15/19）。通过皮肤试验和 BAT 分别识别出 36.8%（7/19）和 26.3%（5/19）的 NMBAs 交叉反应性。皮肤试验和 BAT 之间的一致性（罪魁祸首和交叉反应性 NMBA）对于每种 NMBA 分别为 73.6%（14/19）和 100%（19/19）。在 7 例 NMBA 过敏患者中，安全使用了经皮肤试验阴性的 NMBA。在非过敏组中，100%的患者皮肤试验结果均为阴性，而 BAT 结果阳性一次（CD63 上调）。
在我们的技术条件下，BAT 不能替代皮肤试验来评估 NMBA 过敏。
