Immunology and allergy clinics of North America
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Anaphylactic reactions to neuromuscular blocking agents during general anesthesia constitute a major cause of concern and a great source of debate among anesthesiologists. The authors' recent investigations, taking the striking differences of incidence between Norway and Sweden as the point of departure, have provided valuable insights into the pathogenetic mechanisms and the highly uneven geographical distribution of these rare, but dramatic and notoriously unpredictable, events. ⋯ This new knowledge led to the withdrawal of the drug from the Norwegian market and to the examination of the role of pholcodine-containing drugs in other countries. The present article is a brief summary of the research behind this development.
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Immunol Allergy Clin North Am · Aug 2009
ReviewThe basophil activation test in immediate-type drug allergy.
Diagnosis of drug allergy involves first the recognition of sometimes unusual symptoms as drug allergy and, second, the identification of the eliciting drug. This is an often difficult task, as the clinical picture and underlying pathomechanisms are heterogeneous. In clinical routine, physicians frequently have to rely upon a suggestive history and eventual provocation tests, both having their specific limitations. ⋯ In BAT, these alterations can be detected rapidly on a single-cell basis by multicolor flow cytometry using specific monoclonal antibodies. Combining this technique with in vitro passive sensitization of donor basophils with patients' serum, one can prove the IgE dependence of a drug reaction. This article summarizes the authors' current experience with the BAT in the diagnostic management of immediate-type drug allergy mediated by drug-specific IgE antibodies.
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Skin tests with drugs help determine the cause and mechanism of drug hypersensitivity reactions. The diagnosis of adverse drug reactions is based primarily on history and clinical presentation. ⋯ These tests often are more sensitive than laboratory assays for IgE antibodies to drug allergens, which are available only for a few drugs. Because intradermal skin tests occasionally induce adverse events, they should be performed by experienced personnel in an adequate environment.
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The incidence of immune-mediated anaphylaxis during anesthesia ranges from 1 in 10,000 to 1 in 20,000. Neuromuscular blocking agents represent the most frequently involved substances, followed by latex and antibiotics, but every drug or substance used may be involved. Diagnosis relies on tryptase measurements at the time of the reaction and skin tests and specific IgE or basophil activation assays.
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Immunol Allergy Clin North Am · Aug 2009
ReviewImmediate and delayed reactions to radiocontrast media: is there an allergic mechanism?
Radiocontrast media can cause immediate (1 hour) and nonimmediate (>1 hour) hypersensitivity reactions that remain unpredictable and a cause of concern for radiologists and cardiologists. Immediate hypersensitivity reactions resemble anaphylaxis, whereas nonimmediate ones clinically are predominated by exanthemas. ⋯ It may have an important role in the selection of a safe product in previous reactors, although validation data are still lacking. In vitro tests to search for contrast media-specific cell activation are currently under investigation.