Antigen specific quantification of sulfidoleukotrienes in patients allergic to Betalactam antibiotics.
BACKGROUND
After in vitro allergen-specific stimulation, basophils become activated and release sulfidoleukotrienes LTC4, LTD4 and LTE4. This can be detected by means of the CAST assay. We assessed the positivity criteria and the reliability of antigen-specific sulfidoleukotriene production (CAST) in the in vitro diagnosis of betalactam (BL) allergic patients.


METHODS
We studied a sample of 67 patients (age 48.94 +/- 15.76 years) who had presented with anaphylaxis or urticaria-angioedema within the first 60 minutes after administration of Amoxicillin (54/67), Penicillin G (7/67), Cefuroxime (5/67) or Cefazoline (1/67). All of them had a positive skin test to at least one of the antigenic determinants of Penicillin. As control group 30 adults with negative skin tests who tolerated BL were included. All of them underwent skin tests, oral provocation tests, specific IgE (CAP-FEIA, Pharmacia) and CAST.


RESULTS
Positivity criteria were established by means of ROC curves: a sLT release induced by Betalactams of at least 100 pg/ml and greater than or equal to 3 times the basal value. The overall sensitivity of CAST is 47.7% and specificity 83.3%. Sensitivity of specific IgE is 37.8% and specificity 83.3%.


CONCLUSIONS
We have established validated positivity criteria for the CAST technique in patients allergic to Betalactams. This technique is a useful in vitro diagnostic method in patients with IgE-mediated allergy to Betalactam antibiotics.
García-Avilés
C
C
Departamento de Alergología e Inmunología Clínica, Clínica Universitaria de Navarra, Pamplona, Spain. mcaviles@unav.es
Sanz
M L
ML
Gamboa
P M
PM
Urrutia
I
I
Antépara
I
I
Jauregui
I
I
De Weck
A L
AL
D000658:Amoxicillin / Q000009:adverse effects / Q000276:immunology; D000707:Anaphylaxis / Q000276:immunology; D000799:Angioedema / Q000276:immunology; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000276:immunology*; D002437:Cefazolin / Q000009:adverse effects / Q000276:immunology; D002444:Cefuroxime / Q000009:adverse effects / Q000276:immunology; D004342:Drug Hypersensitivity / Q000276:immunology*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis; D007769:Lactams / Q000009:adverse effects / Q000276:immunology*; D017997:Leukotriene C4 / Q000032:analysis / Q000276:immunology; D017998:Leukotriene D4 / Q000032:analysis / Q000276:immunology; D017999:Leukotriene E4 / Q000032:analysis / Q000096:biosynthesis; D015289:Leukotrienes / Q000032:analysis* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010400:Penicillin G / Q000009:adverse effects / Q000276:immunology; D012882:Skin Tests; D014581:Urticaria / Q000276:immunology
D000900:Anti-Bacterial Agents; D007769:Lactams; D015289:Leukotrienes; D017997:Leukotriene C4; D007073:Immunoglobulin E; D017998:Leukotriene D4; D017999:Leukotriene E4; D000658:Amoxicillin; D002437:Cefazolin; D002444:Cefuroxime; D010400:Penicillin G