Screening for mast cell tryptase and serum IgE antibodies in 18 patients with anaphylactic shock during general anaesthesia.
BACKGROUND
In the perioperative setting multiple agents can cause anaphylaxis. Often the reactions are dramatic, and due to their lifethreatening potential it is crucial that the responsible agent is identified in order to avoid future adverse reactions. The aim of the present study was to measure the concentration of serum mast cell tryptase (MCT), to investigate the prevalence of serum IgE antibodies against ammonium groups, choline, morphine, suxamethonium, thiopentone and latex and to perform skin prick tests (SPTs) in 18 patients experiencing an anaphylactic reaction during induction of general anaesthesia.


METHODS
Serum samples from 18 patients with an anaphylactic reaction during general anaesthesia were analyzed for MCT and specific IgE against ammonium groups, choline, morphine, suxamethonium, thiopentone and latex. Skin prick tests were performed in 11 out of 18 patients.


RESULTS
Ten patients had elevated MCT levels and specific IgE against ammonium ion, morphine and (with the exception of patient nos 3, 9 and 10) suxamethonium. Seven of these patients had positive SPTs to suxamethonium. One of the patients tested positive to latex in addition to suxamethonium. Two patients showed elevated MCT, while specific IgE against the drugs tested was not detected. Three patients tested positive to ammonium ion, morphine and suxamethonium, but negative to MCT. Three patients tested negative to both MCT and specific IgE.


CONCLUSIONS
Fifteen out of 18 sera tested positive for MCT and/or specific IgE against neuromuscular blocking drugs (NMBDs). Ten of the 18 patients experienced an IgE-mediated anaphylactic reaction to NMBDs during anaesthesia, verified by detection of specific IgE and elevated levels of MCT.
Dybendal
T
T
Haukeland Hospital Pharmacy, Haukeland University Hospital, Bergen, Norway. sykehusapoteket.kongsvinger@apotek.no
Guttormsen
A B
AB
Elsayed
S
S
Askeland
B
B
Harboe
T
T
Florvaag
E
E
D000328:Adult; D000701:Analgesics, Opioid / Q000276:immunology; D000707:Anaphylaxis / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis / Q000276:immunology*; D000768:Anesthesia, General; D018686:Anesthetics, Intravenous / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D002794:Choline / Q000276:immunology; D004342:Drug Hypersensitivity / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D007840:Latex / Q000276:immunology; D008297:Male; D008407:Mast Cells / Q000201:enzymology*; D009020:Morphine / Q000276:immunology; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects / Q000276:immunology*; D009467:Neuromuscular Depolarizing Agents / Q000276:immunology; D000644:Quaternary Ammonium Compounds / Q000276:immunology; D012697:Serine Endopeptidases / Q000097:blood*; D012882:Skin Tests; D013390:Succinylcholine / Q000276:immunology; D013874:Thiopental / Q000276:immunology; D053802:Tryptases
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D015415:Biomarkers; D007840:Latex; D009466:Neuromuscular Blocking Agents; D009467:Neuromuscular Depolarizing Agents; D000644:Quaternary Ammonium Compounds; D007073:Immunoglobulin E; D009020:Morphine; D012697:Serine Endopeptidases; D053802:Tryptases; D013390:Succinylcholine; D013874:Thiopental; D002794:Choline