Faculty of Medicine and Health Science, Department of Immunology, Allergology, and Rheumatology, Antwerp University Hospital, and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium; Faculty of Medicine and Health Science, Department of Paediatrics, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium.
Faculty of Medicine and Health Science, Department of Immunology, Allergology, and Rheumatology, Antwerp University Hospital, and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.
J Allergy Clin Immunol Pract. 2022 Apr;10(4):1057-1062.e2. doi: 10.1016/j.jaip.2021.10.066. Epub 2021 Nov 10.
The optimal timing of diagnostic testing for perioperative hypersensitivity (POH) remains unknown. It has been recommended that investigation is best carried out at least 4 to 6 weeks after the event. On the other hand, guidelines discourage the use of in vitro tests later than 3 years after the index reaction.
This retrospective study aimed to assess the reliability of early and late skin tests (STs). It also attempted to verify whether discouraging late ex vivo and in vitro tests is substantiated.
For the first aim, patients were stratified over three epochs: an early timing group, with investigations performed within 6 weeks; a recommended timing group, with tests performed between 6 weeks and 6 months; and a late timing group, tested later than 6 months after the event. For the second study purpose, we studied the reliability of specific IgE quantification and basophil activation test rocuronium within 6 weeks and after 3 years in patients who experienced an ST-proven POH to rocuronium.
A total of 677 patients were included. Based on a positive ST result, a causative agent was found in 74.2% of the early timing group, 62.6% of the recommended timing group, and 50% of the late timing group. A positive specific IgE for rocuronium or morphine was found in 80% of patients tested within 6 weeks, 63% of patients tested between 6 weeks and 3 years, and 50% of patients tested more than 3 years after the event. A positive basophil activation test was found in 83.3%, 51%, and 20%, respectively, of patients.
Our data confirm that evaluation of drug allergy for suspected POH can be performed before 6 weeks after the event, and there is no maximal upper time limit disclosing ex vivo and in vitro testing.
围手术期过敏反应（POH）的诊断检测最佳时机仍不清楚。据建议，在事件发生后至少 4 至 6 周进行调查最为合适。另一方面，指南不鼓励在索引反应后 3 年内使用体外检测。
本回顾性研究旨在评估早期和晚期皮肤试验（ST）的可靠性。它还试图验证是否有理由不鼓励晚期体外和体内检测。
为了实现第一个目标，患者分为三个时期：早期时间组，在 6 周内进行检查；推荐时间组，在 6 周至 6 个月之间进行检查；晚期时间组，在事件发生后 6 个月后进行检查。为了实现第二个研究目的，我们研究了在 ST 证实对罗库溴铵发生 POH 的患者中，在 6 周内和 3 年后进行特异性 IgE 定量和嗜碱性粒细胞活化试验罗库溴铵的可靠性。
共纳入 677 例患者。根据阳性 ST 结果，在早期时间组、推荐时间组和晚期时间组中，分别有 74.2%、62.6%和 50%的患者找到了病因。在 6 周内接受检测的患者中，80%的患者发现了对罗库溴铵或吗啡的特异性 IgE，63%的患者在 6 周至 3 年内接受了检测，50%的患者在事件发生 3 年后接受了检测。嗜碱性粒细胞活化试验阳性率分别为 83.3%、51%和 20%。
我们的数据证实，在事件发生后 6 周内可以对疑似 POH 的药物过敏进行评估，并且没有发现体外和体内检测的最大上限时间。
