Gueant J L, Aimone-Gastin I, Namour F, Laroche D, Bellou A, Laxenaire M C
Laboratoire de Biochimie Cellulaire et Moléculaire en Nutrition, Faculté de Médecine, Université H. Poincaré-Nancy, Vandoeuvre-les-Nancy, France.
Clin Exp Allergy. 1998 Sep;28 Suppl 4:65-70.
Immediate adverse reactions to anaesthetics have an immune mechanism in more than 50% of the cases. They are mainly due to muscle relaxant drugs. A prospective evaluation of tryptase, histamine and serotonin for diagnosing anaphylaxis to anaesthetics was performed over 2 years. The sensitivity of each marker was at 60-70% and it reached 80% when combining tryptase and histamine. Specific IgE have been already observed in serum from patients allergic to muscle relaxant, thiopentone, morphine, phenoperidine, propofol and radio-contrast media. However, the recent progress in the identification of drug epitopes by Sepharose-solid drug phase IgE radioimmunoassay has to be reconsidered as non-specific binding of hydrophobic drugs such as propofol to hydrophobic serum IgE has been observed recently in patients with drug allergy. In addition, association of drugs such as propofol and muscle relaxant may potentiate the mediator release by a non-elucidated mechanism.
超过50%的麻醉即刻不良反应具有免疫机制。它们主要由肌肉松弛药物引起。在两年时间里对用于诊断麻醉过敏反应的类胰蛋白酶、组胺和血清素进行了前瞻性评估。每种标志物的敏感性为60%-70%，当将类胰蛋白酶和组胺联合使用时，敏感性达到80%。在对肌肉松弛剂、硫喷妥钠、吗啡、苯哌替啶、丙泊酚和放射性造影剂过敏的患者血清中已观察到特异性IgE。然而，由于最近在药物过敏患者中观察到疏水性药物如丙泊酚与疏水性血清IgE的非特异性结合，通过琼脂糖固相药物相IgE放射免疫测定法鉴定药物表位的最新进展必须重新考虑。此外，丙泊酚和肌肉松弛剂等药物的联合使用可能通过一种尚未阐明的机制增强介质释放。
