title: IgE to Poppy Seed and Morphine Are Not Useful Tools to Diagnose Opiate Allergy.
abstract: BACKGROUND
  Correct diagnosis of genuine IgE-mediated opiate allergy poses a significant challenge, mainly because of uncertainties associated with opiate skin testing and the unavailability of drug-specific IgE (sIgE) assays. Recently, it has been suggested that sIgE to poppy seed extract and morphine would be reliable in the diagnosis of opiate allergy. However, given the high prevalence of sIgE antibodies to these compounds in an allergic population, the predictive value of these tests leaves significant doubts.
  
  
  OBJECTIVE
  This study aims at verifying the predictive value of positive poppy seed and morphine sIgE assays results.
  
  
  METHODS
  A total of 22 individuals with a positive sIgE to poppy seed or morphine were selected. All had controlled drug challenges with increasing doses of morphine and/or codeine. Of these, 18 patients had an additional basophil activation test (BAT) with morphine and codeine.
  
  
  RESULTS
  None of the 22 patients demonstrated objective or subjective symptoms on provocation with morphine and/or codeine. Regarding BAT with morphine and codeine, expression of CD63 on basophils from 14 opiate tolerant individuals remained comparable to spontaneous expression by resting cells. The remaining 4 patients were classified as nonresponders.
  
  
  CONCLUSIONS
  Positive sIgE results to poppy seed and morphine are not per se predictive for genuine opiate allergy and should not be used in isolation to diagnose morphine or codeine allergy. To avoid overdiagnosis, for the time being, we propose to supplement serological diagnosis with an oral provocation test. Whether BAT might help to discriminate between clinical reactivity and sensitization remains to be confirmed in larger collaborative studies.
authors.affiliation: Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Antwerpen, Belgium.
authors.forename: Athina L
authors.initials: AL
authors.lastname: Van Gasse
authors.affiliation: Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Antwerpen, Belgium; Department of Pediatrics, Antwerp University Hospital, Antwerpen, Belgium.
authors.forename: Margo M
authors.initials: MM
authors.lastname: Hagendorens
authors.affiliation: Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Antwerpen, Belgium.
authors.forename: Vito
authors.initials: V
authors.lastname: Sabato
authors.affiliation: Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Antwerpen, Belgium.
authors.forename: Chris H
authors.initials: CH
authors.lastname: Bridts
authors.affiliation: Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Antwerpen, Belgium.
authors.forename: Luc S
authors.initials: LS
authors.lastname: De Clerck
authors.affiliation: Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Antwerpen, Belgium. Electronic address: immuno@uantwerpen.be.
authors.forename: Didier G
authors.initials: DG
authors.lastname: Ebo
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D015549:Basophil Degranulation Test; D015415:Biomarkers / Q000097:blood; D003061:Codeine / Q000276:immunology; D004342:Drug Hypersensitivity / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D010207:Papaver / Q000009:adverse effects / Q000276:immunology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012639:Seeds / Q000009:adverse effects / Q000276:immunology*; D012698:Serologic Tests; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D015415:Biomarkers; D007073:Immunoglobulin E; D009020:Morphine; D003061:Codeine
keywords: Allergy; Basophil activation; Codeine; IgE; Morphine; Opiate; Poppy seed