Screening for mast cell tryptase and serum IgE antibodies in 18 patients with anaphylactic shock during general anaesthesia

Dybendal, T.; Guttormsen, Anne Berit; El-Sayed, Shereen S; Askeland, B.; Harboe, T.; Florvaag, Erik

doi:10.1046/j.1399-6576.2003.00237.x

Cited by 66 publications

(46 citation statements)

References 28 publications

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“…Additionally, after initiating a cardiopulmonary bypass which stabilized patient hemodynamic collapse, we obtained a blood sample to test for mast cell tryptase. This approach is in agreement with current practice of diagnosing anaphylaxis during the perioperative period [3,4]. The test came positive, confirming the occurrence of severe anaphylactic reaction.…”

supporting

confidence: 88%

“…Indeed, several medications used to induce and maintain general anaesthesia have been described as strong allergens. The most common are non-depolarizing muscle relaxants and antibiotics [2,3]. Dr. Kounis and colleagues have suggested that salbutamol could aggravate hemodynamic collapse; this is an excellent point as this beta mimetic certainly causes tachycardia, which can worsen hemodynamic compromise in patients suffering from HOCM, Additionally, they suggested that preservatives present in ampoules of epinephrine (for example, sulphites) may also contribute to allergic reactions.…”

mentioning

confidence: 99%

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In response to: Anaphylaxis during cardiac surgery for hypetrophic cardiomyopathy: pathophysiologic and therapeutic considerations

Wąsowicz

Yee

2017

Anaesthesiol Intensive Ther

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We are most appreciative for the comments from Dr. Nicholas G. Kounis [1] and his colleagues regarding our recent publication describing the challenging case of anaphylactic shock in patients suffering from hypertrophic obstructive cardiomyopathy (HOCM) scheduled for surgical treatment, namely myectomy [2] Their letter raises several important concerns regarding anaphylaxis in anaesthesia and particularly in patients with HOCM. Before we address each point, we would like to mention that several topics discussed by authors were mentioned in our case report but could not be described in detail due to space limitations. In this context, several comments made by Dr. Kounis provide excellent complimentary information to our case reports.The authors of this letter have indicated that the diagnosis of anaphylaxis may be difficult while the patient is under general anaesthesia and subsequently during emerge from anaesthesia [3]. In the described case, patient presented several symptoms typical for severe anaphylactic reaction: arterial hypotension, high airway pressures, airway swelling and skin rash. Additionally, after initiating a cardiopulmonary bypass which stabilized patient hemodynamic collapse, we obtained a blood sample to test for mast cell tryptase. This approach is in agreement with current practice of diagnosing anaphylaxis during the perioperative period [3,4]. The test came positive, confirming the occurrence of severe anaphylactic reaction. Finally, after recovery following cardiac surgery, the patient was referred to an allergologist and additional skin tests confirmed a strong sensitivity to chlorhexidine.

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supporting

confidence: 88%

mentioning

confidence: 99%

In response to: Anaphylaxis during cardiac surgery for hypetrophic cardiomyopathy: pathophysiologic and therapeutic considerations

Wąsowicz

Yee

2017

Anaesthesiol Intensive Ther

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“…Mast cell tryptase also circulates in the body, and although serum tryptase levels are quite low in healthy individuals (Ͻ1 ϫ 10 Ϫ10 M), they can be 10 -100-fold higher in patients undergoing anaphylactic reactions (21). Although low concentrations of tryptase (5.2 ϫ 10 Ϫ11 M) did not activate chemerin, higher concentrations (5.2 ϫ 10 Ϫ9 M) served as a potent activator (TABLE ONE).…”

Section: Serinementioning

confidence: 99%

Chemerin Activation by Serine Proteases of the Coagulation, Fibrinolytic, and Inflammatory Cascades

Zabel

Allen

Kulig

et al. 2005

Journal of Biological Chemistry

326

311

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Proteases function at every level in host defense, from regulating vascular hemostasis and inflammation to mobilizing the "rapid responder" leukocytes of the immune system by regulating the activities of various chemoattractants. Recent studies implicate proteolysis in the activation of a ubiquitous plasma chemoattractant, chemerin, a ligand for the G-protein-coupled receptor CMKLR1 present on plasmacytoid dendritic cells and macrophages. To define the pathophysiologic triggers of chemerin activity, we evaluated the ability of serum-and inflammation-associated proteases to cleave chemerin and stimulate CMKLR1-mediated chemotaxis. We showed that serine proteases factor XIIa and plasmin of the coagulation and fibrinolytic cascades, elastase and cathepsin G released from activated neutrophil granules and mast cell tryptase are all potent activators of chemerin. Activation results from cleavage of the labile carboxyl terminus of the chemoattractant at any of several different sites. Activation of chemerin by the serine protease cascades that trigger rapid defenses in the body may direct CMKLR1-positive plasmacytoid dendritic cell and tissue macrophage recruitment to sterile sites of tissue damage, as well as trafficking to sites of infectious and allergic inflammation.A network of serine proteases regulates the primary response to injury and infection in the host. Serine proteases of the coagulation and fibrinolytic cascades mediate the homeostatic response to blood vessel injury. Kallikrein and factor XIIa process kininogens to generate bradykinin, a potent vasodilator that triggers increased vascular permeability during inflammation. Serine proteases termed convertases release multiple pathogen-neutralizing components of activated complement. Serine protease cascades also regulate the recruitment of phagocytic and antigen-presenting cells to sites of inflammation and tissue damage. The complement cascade, for example, releases active components C5a and C3a, potent attractants for many leukocytes, including neutrophils and monocytes (1, 2). Thus serine proteases are critical participants in rapid defense mechanisms in the body.We and others have recently identified chemerin as a potent chemoattractant for cells expressing the G-protein-linked receptor chemokine-like receptor 1 (CMKLR1), 5 also known as ChemR23 or DEZ (3-5). CMKLR1 is expressed in vitro by monocyte-derived macrophages and dendritic cells (3,5,6) and in vivo by circulating plasmacytoid dendritic cells (pDCs) (5) and tissue macrophages.6 pDCs are major producers of ␣-interferons and can differentiate into antigen-presenting cells capable of triggering T effector or suppressor responses (7). Tissue macrophages have a major role as phagocytes but, similar to pDCs, are also implicated in bridging innate and adaptive immune responses and in regulating immunity in sterile versus infectious tissue injury (8). Importantly, chemerin is widely expressed and circulates in human plasma in an inactive state (5). Active forms of chemerin have been isolated from hu...

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“…It is practically impossible to perform a skin test on every medication administered during anaesthesia for every patient. 9,10 The diagnosis of anaphylactic reactions is difficult to make during the induction of anaesthesia when various types of medication are used simultaneously. Therefore, it is mandatory to make a prompt diagnosis, and to provide a proper treatment for its occurrence.…”

Section: Resultsmentioning

confidence: 99%

Two cases of anaphylaxis under anaesthesia with vecuronium

Ravi

Vijay

Shouche

2015

Medical Journal Armed Forces India

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Screening for mast cell tryptase and serum IgE antibodies in 18 patients with anaphylactic shock during general anaesthesia

Abstract: Fifteen out of 18 sera tested positive for MCT and/or specific IgE against neuromuscular blocking drugs (NMBDs). Ten of the 18 patients experienced an IgE-mediated anaphylactic reaction to NMBDs during anaesthesia, verified by detection of specific IgE and elevated levels of MCT.

Cited by 66 publications

References 28 publications

In response to: Anaphylaxis during cardiac surgery for hypetrophic cardiomyopathy: pathophysiologic and therapeutic considerations

In response to: Anaphylaxis during cardiac surgery for hypetrophic cardiomyopathy: pathophysiologic and therapeutic considerations

Chemerin Activation by Serine Proteases of the Coagulation, Fibrinolytic, and Inflammatory Cascades

Two cases of anaphylaxis under anaesthesia with vecuronium

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