Basophil Activation in the Diagnosis of Life-Threatening Hypersensitivity Reaction to Iodinated Contrast Media: A Case Report

Philipse, E.; Sabato, Vito; Bridts, Chris H.; Clerck, L. De; Ebo, Didier G.

doi:10.2143/acb.3251

Cited by 13 publications

(8 citation statements)

References 5 publications

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“…Other IgE‐independent reactions like those caused by NSAIDs were not clustered within the food model. However, the mechanisms of other drug‐triggers like iomeprol, carmellose and moxifloxacin are not clearly defined 38–43 . Iomeprol (not classified with food anaphylaxis with a prediction score of 73%) has been strongly suggested to trigger IgE‐mediated hypersensitivity by a diagnostic workup using basophil activation test 39,40 .…”

Section: Discussionmentioning

confidence: 99%

Characterization of anaphylaxis reveals different metabolic changes depending on severity and triggers

Perales-Chordá

Obeso

Twomey

et al. 2021

Clin Experimental Allergy

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Background Despite the increasing incidence of anaphylaxis, its underlying molecular mechanisms and biomarkers for appropriate diagnosis remain undetermined. The rapid onset and potentially fatal outcome in the absence of managed treatment prevent its study. Up today, there are still no known biomarkers that allow an unequivocal diagnosis. Therefore, the aim of this study was to explore metabolic changes in patients suffering anaphylactic reactions depending on the trigger (food and/or drug) and severity (moderate and severe) in a real‐life set‐up. Methods Eighteen episodes of anaphylaxis, one per patient, were analysed. Sera were collected during the acute phase (T1), the recovery phase (T2) and around 2–3 months after the anaphylactic reaction (T0: basal state). Reactions were classified following an exhaustive allergological evaluation for severity and trigger. Sera samples were analysed using untargeted metabolomics combining liquid chromatography coupled to mass spectrometry (LC‐MS) and proton nuclear magnetic resonance spectroscopy (1H‐NMR). Results ‘Food T1 vs T2’ and ‘moderate T1 vs T2’ anaphylaxis comparisons showed clear metabolic patterns during the onset of an anaphylactic reaction, which differed from those induced by drugs, food + drug or severe anaphylaxis. Moreover, the model of food anaphylaxis was able to distinguish the well‐characterized IgE (antibiotics) from non‐IgE‐mediated anaphylaxis (nonsteroidal anti‐inflammatory drugs), suggesting a differential metabolic pathway associated with the mechanism of action. Metabolic differences between ‘moderate vs severe’ at the acute phase T1 and at basal state T0 were studied. Among the altered metabolites, glucose, lipids, cortisol, betaine and oleamide were observed altered. Conclusions The results of this exploratory study provide the first evidence that different anaphylactic triggers or severity induce differential metabolic changes along time or at specific time‐point, respectively. Besides, the basal status T0 might identify high‐risk patients, thus opening new ways to understand, diagnose and treat anaphylaxis.

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Section: Discussionmentioning

confidence: 99%

Characterization of anaphylaxis reveals different metabolic changes depending on severity and triggers

Perales-Chordá

Obeso

Twomey

et al. 2021

Clin Experimental Allergy

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“…Nevertheless, 0.04% of patients experience severe reactions upon administration of non-ionic RCM (Wolf et al, 1989 ; Katayama et al, 1990 ; Lieberman and Seigle, 1999 ). Traditionally, RCM reactions have been considered as non-IgE-mediated, and the majority of DHRs indeed seem to result from RCM non-specifically binding to surface receptors or indirectly interfering with the complement or kinin cascades, but skin testing and BAT have been successfully applied more recently (Brockow et al, 2009 ; Javaloyes et al, 2012 ; Philipse et al, 2013 ). Still few anecdotal reports on RCM-specific IgE exist, therefore, some studies have sought to differentiate IgE- from non-IgE-mediated mechanisms, however, have not determined the presence of drug-specific IgE themselves.…”

Section: Bat For the Evaluation Of Immediate Drug Hypersensitivity Tomentioning

confidence: 99%

Basophil Reactivity as Biomarker in Immediate Drug Hypersensitivity Reactions—Potential and Limitations

2016

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Immediate drug hypersensitivity reactions (DHRs) resemble typical immunoglobulin E (IgE)-mediated symptoms. Clinical manifestations range from local skin reactions, gastrointestinal and/or respiratory symptoms to severe systemic involvement with potential fatal outcome. Depending on the substance group of the eliciting drug the correct diagnosis is a major challenge. Skin testing and in vitro diagnostics are often unreliable and not reproducible. The involvement of drug-specific IgE is questionable in many cases. The culprit substance (parent drug or metabolite) and potential cross-reacting compounds are difficult to identify, patient history and drug provocation testing often remain the only means for diagnosis. Hence, several groups proposed basophil activation test (BAT) for the diagnosis of immediate DHRs as basophils are well-known effector cells in allergic reactions. However, the usefulness of BAT in immediate DHRs is highly variable and dependent on the drug itself plus its capacity to spontaneously conjugate to serum proteins. Stimulation with pure solutions of the parent drug or metabolites thereof vs. drug-protein conjugates may influence sensitivity and specificity of the test. We thus, reviewed the available literature about the use of BAT for diagnosing immediate DHRs against drug classes such as antibiotics, radio contrast media, neuromuscular blocking agents, non-steroidal anti-inflammatory drugs, and biologicals. Influencing factors like the selection of stimulants or of the identification and activation markers, the stimulation protocol, gating strategies, and cutoff definition are addressed in this overview on BAT performance. The overall aim is to evaluate the suitability of BAT as biomarker for the diagnosis of immediate drug-induced hypersensitivity reactions.

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“…However, this correlation appears to be poorly related to an immediate hypersensitivity reaction (IHR). The optimistic conclusions reported by the authors were echoed by other reports, where hypersensitivity to iodinated radiologic contrast media was evaluated to occur in 1–3% of patients and the possibility of shortening the diagnostic workup with BATs was announced as the main advantage of this test . Contrast material is generally well tolerated although approximately 1% of patients who receive low‐osmolar nonionic contrast material will develop anaphylaxis symptoms.…”

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confidence: 86%

Basophil activation test (BAT) in the diagnosis of immediate hypersensitivity reactions to radiocontrast media

Chirumbolo

Torres

2013

Allergy

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4. Johansson SGO, Adedoyin J, van Hage M, Gronneberg R, Nopp A. False-positive penicillin immunoassay: an unnoticed common problem. J Allergy Clin Immunol 2013;132:235-237. 5. Aberer W, Zidarn M, Kranke B. IgE antibodies to penicillin are indicative for but not conclusive proof of penicillin allergy. Br J Dermatol 2006;154:1209-1210. 6. Kopac P, Zidarn M, Kosnik M. Epidemiology of hypersensitivity reactions to penicillin in Slovenia. Acta Dermatovenerol Alp Panonica Adriat 2012;21:65-67. R E P L YWe thank our colleagues for their valuable contribution to the ongoing debate on diagnostic precision of various in vitro and in vivo tests in the diagnosis of penicillin allergy. Our opinion is in line with theirs, namely that the precision of the tests applied should be evaluated against a gold standard, that is, oral or intravenous challenge with the culprit drug (except, of course, in cases of for example TEN, StevensJohnsons syndrome, DRESS, AGEP, or vasculitis, but including anaphylaxis). This strategy has, however, not been included in the present international guidelines. For safety reasons, we have chosen a research strategy addressing the different steps in the diagnosis of penicillin allergy separately, that is, first to look upon the value of case history and the validity of the challenge procedures. These data are presented in our paper (1). Currently we are assessing the value of skin testing in our patients and are finalizing a case series of oral challenge of patients with positive immediate intracutaneous test to penicillin(s), which will be followed by a protocol looking at oral challenge of patients with positive IgE to penicillin(s). Conflicts of interestNone declared.

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Basophil Activation in the Diagnosis of Life-Threatening Hypersensitivity Reaction to Iodinated Contrast Media: A Case Report

Cited by 13 publications

References 5 publications

Characterization of anaphylaxis reveals different metabolic changes depending on severity and triggers

Characterization of anaphylaxis reveals different metabolic changes depending on severity and triggers

Basophil Reactivity as Biomarker in Immediate Drug Hypersensitivity Reactions—Potential and Limitations

Basophil activation test (BAT) in the diagnosis of immediate hypersensitivity reactions to radiocontrast media

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