Cellular in vitro diagnosis of adverse drug reactions

Möbs, Christian; Pfützner, Wolfgang

doi:10.1007/s40629-014-0020-6

Cited by 19 publications

(15 citation statements)

References 53 publications

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“…Diagnostic methods to identify the culprit allergen: cellular diagnosis of immediate allergies There are a number of functional assays that can detect cellbound IgE to beta-lactams [92]. Basophils in peripheral blood, on the surface of which allergen-specific IgE antibodies are found, act as effector cells.…”

Section: Notementioning

confidence: 99%

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Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics

et al. 2019

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Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics 121 guidelines Abstract This guideline on diagnostic procedures for suspected beta-lactam antibiotic (BLA) hypersensitivity was written by the German and Austrian professional associations for allergology, and the Paul-Ehrlich Society for Chemotherapy in a consensus procedure according to the criteria of the German Association of Scientific Medical Societies. BLA such as penicillins and cephalosporins represent the drug group that most frequently triggers drug allergies. However, the frequency of reports of suspected allergy in patient histories clearly exceeds the number of confirmed cases. The large number of suspected BLA allergies has a significant impact on, e.g., the quality of treatment received by the individual patient and the costs to society as a whole. Allergies to BLA are based on different immunological mechanisms and often manifest as maculopapular exanthema, as well as anaphylaxis; and there are also a number of less frequent special clinical manifestations of drug allergic reactions. All BLA have a beta-lactam ring. BLA are categorized into different classes: penicillins, cephalosporins, carbapenems, monobactams, and beta-lactamase inhibitors with different chemical structures. Knowledge of possible cross-reactivity is of considerable clinical significance. Whereas allergy to the common beta-lactam ring occurs in only a small percentage of all BLA allergic patients, cross-reactivity due to side chain similarities, such as aminopenicillins and aminocephalosporins, and even methoxyimino cephalosporins, are more common. However, the overall picture is complex and its elucidation may require further research. Diagnostic procedures used in BLA allergy are usually made up of four components: patient history, laboratory diagnostics, skin testing (which is particularly important), and drug provocation testing. The diagnostic approach-even in cases where the need to administer a BLA is acute-is guided by patient history and risk-benefit ratio in the individual case.

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Section: Notementioning

confidence: 99%

“…The following test methods are available following T-cell stimulation by the suspected drug [81,92]:…”

Section: Recommendationsmentioning

confidence: 99%

Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics

et al. 2019

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“…In-vitro-Tests. Zu den In-vitro-Tests zählen IgE-Analytik und zelluläre Assays [78]. Standardisierte Testverfahren zum Nachweis von IgE-Antikörpern stehen allerdings nur für wenige Substanzen wie verschiedene Betalaktame (Penicillin und Aminopenicilline), Chlorhexidin, Gelatine, Ethylenoxid und Latex zur Verfügung.…”

Section: Caveunclassified

“…Zelluläre Tests beruhen auf dem Nachweis einer Aktivierung von basophilen Granulozyten durch das eingesetzte Arzneimittel. Sie gelten zwar als sehr spezifisch, sind aufgrund der relativ geringen Sensitivität, des Bedarfs an Frischblut und des arbeitstechnischen Aufwands jedoch aktuell speziellen Fragestellungen und Laboren mit entsprechender Expertise in ihrer Durchführung vorbehalten [78].…”

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Perioperative Anaphylaxie auf Arzneimittel

Pfützner¹,

Wulf²

2017

Anästhesiol Intensivmed Notfallmed Schmerzther

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The diagnostic evaluation of perioperative anaphylaxia is of great importance for the medical care of the affected persons in the context of renewed interventions in general anesthesia. The most frequent triggers include muscle relaxants, antibiotics, latex and analgesics of the type of the cyclooxygenase inhibitors, but other perioperatively administered drugs such as opioids, anesthetics, benzodiazepines, dyes, disinfectants and even corticosteroids or drug additives may also be the cause in rare cases. The most important aim is therefore the identification of the responsible drug, for which a near-time allergological diagnosis should be carried out within the first 4 weeks to 6 months after the reaction. At the end of the examinations, the patient receives a structured allergy passport, which includes information on the drug reaction, the triggers and alternative medicines, as well as possible preventive measures for future surgical procedures. It should be noted, however, that the latter are not a guarantee that, upon renewed exposure to the causative medicinal product, there will be no, possibly even heavier, anaphylactic reaction.

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“…The intensity of the immune response that characterizes anaphylaxis can be detected in vitro when the blood basophils (the key cells in peripheral blood involved in the development of anaphylaxis) are exposed to the culprit drug, the antigen. Thus, BAT represents a functional diagnostic tool [56]. The activation of the basophils involves complex immunological mechanisms, with intracellular changes followed by the release of the mediators in the systemic circulation.…”

Section: The Principle For the Basophil Activation Tests For Drugsmentioning

confidence: 99%

The Performance of Flowcytometry-Assisted Basophil Activation Tests in the Diagnosis of Drug-Induced Immediate- Type Hypersensitivity Reactions

Petrișor¹,

Sfichi²,

Gherman³

et al. 2016

Proof and Concepts in Rapid Diagnostic Tests and Technologies

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Abstract"ackground Flowcytometry-assisted basophil activation tests ""T are useful in vitro diagnostic tools for drug-induced immediate-type hypersensitivity.Objective The study aimed to perform a medical literature review on the performance of CD ""T.Results Seven studies for antibiotics, eleven for neuromuscular blocking agents NM""s , and for nonsteroidal anti-inflammatory drugs NS"IDs were included. The reference standards such as history, skin tests, challenge tests, and/or IgE, along with the concentrations, varied among studies. The thresholds for ""T positivity varied from basophils in the range greater than %, a net percentage of activated basophils greater than % or a stimulation index ranging .. , to the use of more complex composite indexes for NM""s. For antibiotics and NS"IDs, a stimulation index > was generally chosen. ""T sensitivity for β-lactams was %, while specificity was . %. For NM""s, ""T sensitivity was %, while specificity was %. For NS"IDs, ""T sensitivity was . % and specificity was %.Discussion ""T for the diagnosis of drug hypersensitivity has good specificity, but only moderate sensitivity. Despite the shortcomings and the methodological differences in ""T, the potential benefits to avoid challenge tests and increase the allergologic survey sensitivity have led to their widespread use in the clinical practice and warrant their future standardization.

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Cellular in vitro diagnosis of adverse drug reactions

Cited by 19 publications

References 53 publications

Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics

Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics

Perioperative Anaphylaxie auf Arzneimittel

The Performance of Flowcytometry-Assisted Basophil Activation Tests in the Diagnosis of Drug-Induced Immediate- Type Hypersensitivity Reactions

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