Investigation of drugs responsible for perioperative anaphylactic reactions using cellular allergen stimulation test.
BACKGROUND
Anaphylactic reactions during anesthesia and operation are common and life threatening. Follow-up investigation is necessary for avoiding potential re-exposure of the patients to the offending drugs. The purpose of this study was to assess cellular allergen stimulation test (CAST) as a diagnostic instrument in immunoglobulin E (IgE)- and non-IgE-mediated anaphylactic reactions.


METHODS
This study included 25 patients who developed perioperative anaphylactic reactions and 10 subjects that tolerated anesthetics and other drugs during perioperative period from September 2009 to October 2013 in Peking Union Medical College Hospital. We performed skin tests and flow cytometric analysis of basophil activation-based CAST in all subjects.


RESULTS
Of the 25 patients, 17 had IgE-mediated anaphylactic reactions (causative agent identified by skin tests) and 8 had non-IgE-mediated anaphylactic reactions (negative skin tests). CAST showed a sensitivity of 42.9%, specificity of 90%, and negative predictive value of 80.6% for neuromuscular blocking agents.


CONCLUSIONS
CAST may be useful for the diagnosis of anaphylactic reactions during perioperative period. Our findings call for further investigation to increase the sensitivity of the test.
Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Xin
X
Xin
Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Yi
Y
Zou
Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Lijiao
L
Xing
Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Jia
J
Yin
Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Jianqing
J
Gu
Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Zixi
Z
Wang
Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Yuguang
Y
Huang
Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Jing
J
Zhao
D000328:Adult; D000485:Allergens / Q000276:immunology*; D000707:Anaphylaxis / Q000175:diagnosis*; D004342:Drug Hypersensitivity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D012882:Skin Tests / Q000379:methods*; D055815:Young Adult
D000485:Allergens