title: Flowcytometric diagnosis of atracurium-induced anaphylaxis.
abstract: BACKGROUND
  Allergy to atracurium is a rare condition with serious consequences of diagnostic error. However, correct diagnosis is not always straightforward. The aim of this study is to assess the utility of the basophil activation test (BAT) in atracurium sensitization and to investigate its role in identifying cross-reactivity between muscle relaxants.
  
  
  METHODS
  For validation, eight patients with perioperative anaphylaxis to atracurium and seven individuals experiencing perioperative anaphylaxis but not exposed to neuromuscular blocking agents (NMBA) were included. Furthermore, five other patient groups were included in the study, and all individuals exposed to different NMBA, either sensitized or not to the drug. Basophil activation with atracurium was analysed flow cytometrically.
  
  
  RESULTS
  ROC analyses between eight atracurium-sensitized patients and seven nonexposed controls allowed identification of 5% as the decision threshold for BAT positivity. For this cutoff, the BAT attained a sensitivity of 63%, specificity of 100%, positive predictive value of 100% and negative predictive value of 70%. Of the atracurium-exposed individuals with a negative atracurium skin test (ST), two individuals had a clear positive BAT. BAT atracurium was positive in one cisatracurium-sensitized patient and negative in all cisatracurium-exposed patients with a negative ST to cisatracurium. All rocuronium- and suxamethonium-sensitized patients displayed a negative BAT with atracurium.
  
  
  CONCLUSIONS
  The BAT proves to be a useful diagnostic for atracurium-induced anaphylaxis and may be complementary to STs. The technique enables quick and simultaneous testing of potentially crossreactive NMBA and the identification of safe alternatives for future surgery.
authors: Department of Immunology, Allergology, Rheumatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.
authors: A P
authors: AP
authors: Uyttebroek
authors: V
authors: V
authors: Sabato
authors: J
authors: J
authors: Leysen
authors: C H
authors: CH
authors: Bridts
authors: L S
authors: LS
authors: De Clerck
authors: D G
authors: DG
authors: Ebo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000707:Anaphylaxis / Q000139:chemically induced / Q000175:diagnosis*; D019540:Area Under Curve; D001279:Atracurium / Q000009:adverse effects*; D015549:Basophil Degranulation Test; D002648:Child; D003429:Cross Reactions / Q000276:immunology; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012882:Skin Tests; D055815:Young Adult
chemical_list: D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium
keywords: anaphylaxis; basophil activation test; benzylisoquinolines; cross-reactivity; flow cytometry