Usefulness of Basophil Activation Tests for Diagnosis of Sugammadex-Induced Anaphylaxis

Background: Although cases of anaphylaxis caused by sugammadex have been reported, its incidence remains uncertain. Conversely, no studies have evaluated the incidence of anaphylaxis to neostigmine. Methods: This was a retrospective multicentre observational study of patients who underwent surgery under general anaesthesia between 2012 and 2016 to compare the incidence of anaphylaxis with sugammadex with that of neostigmine at four tertiary hospitals in Japan. To ensure the quality of diagnosis, only cases with a clinical history suggestive of anaphylaxis, along with positive results from in vitro or in vivo testing, were assessed. Results: From a total of 49 532 patients who received general anaesthesia included in this study, 18 cases of anaphylaxis were reported, of which six were attributable to sugammadex and none to neostigmine. There were no fatalities attributable to anaphylaxis. The incidence of anaphylaxis caused by all drugs or by sugammadex was calculated as 0.036% (95% confidence interval [CI]: 0.022e0.057%) and 0.02% (of the number of sugammadex cases) (95% CI: 0.007e0.044%), respectively. Conclusions: The results suggest that neostigmine might be safer than sugammadex when assessing only the incidence of anaphylaxis. We believe that there is room for reconsideration of the choice of reversal agent for neuromuscular blocking agents by all anaesthetists. Clinical trial registration: UMIN000022365; UMIN000033561.

show abstract

“…Assessment of the BAT was performed based on the threshold we determined in our previous study. 23 BAT…”

Section: Resultsmentioning

confidence: 99%

“…The methods of the BATs are detailed elsewhere. 23,24 Briefly, whole blood samples were obtained from patients with allergic reactions. BATs were performed using a flow cytometer (BD FACSCanto™ II Flow Cytometer; Japan BD Co., Tokyo, Japan).…”

Section: Basophil Activation Testsmentioning

confidence: 99%

Comparison of incidence of anaphylaxis between sugammadex and neostigmine: a retrospective multicentre observational study

Orihara

Takazawa

Horiuchi

et al. 2020

British Journal of Anaesthesia

Self Cite

View full text Add to dashboard Cite

show abstract

“…The BAT is based on the upregulation of granule-derived markers expressed at the basophil membrane upon ex vivo activation by the suspected agent. It recently became widely accepted as an additional and reliable tool, with high sensitivity and specificity to identify the causative agent of immediate drug hypersensitivity [14][15][16][17]. Further studies are required to evaluate the usefulness of this tool as a diagnostic approach of anaphylaxis, although diagnostic precision can be improved by combining multiple methods, such as the skin test and the BAT.…”

Section: Discussionmentioning

confidence: 99%

Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background: Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. Case presentation: A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother's vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. Conclusions: This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued.

show abstract

“…While SPTs showed a negative reaction to all the drugs tested, IDTs showed a positive reaction to only 50-μg/ml rocuronium (Table 1 ). We also performed basophil activation tests (BATs) on the same day as the skin tests, detailed methods for which are described elsewhere [ 10 – 12 ]. Briefly, CD203c was used as a marker to detect activated basophils using a flow cytometer (FACSCanto II; BD Biosciences, San Jose, CA).…”

Section: Case Reportmentioning

confidence: 99%

Interpreting the results of early skin tests after perioperative anaphylaxis requires special attention: a case report and review of literature

et al. 2020

Self Cite

View full text Add to dashboard Cite

Skin tests are the gold standard for detecting the culprit drug of anaphylaxis, and should ideally be performed after an interval of 4–6 weeks after the reaction to avoid false-negative results. However, when re-operation cannot be delayed and early allergy tests are necessary, special attention is required during subsequent anesthesia, because early skin tests tend to produce false-negative results. This report presents a case of rocuronium-induced anaphylaxis in which early skin tests showed negative results for all the drugs tested. The second anesthesia was safely performed by avoiding all the drugs used for the first anesthesia. Ultimately, skin tests and basophil activation tests (BATs) performed after re-operation demonstrated rocuronium as the drug responsible for anaphylaxis. We recommend performing BATs in addition to skin tests to improve the accuracy of diagnosis of anaphylaxis. In this report, we also discuss interpretation of the results of early skin tests and subsequent selection of drugs for anesthesia. After postponement of surgery due to anaphylaxis, we are often required to perform allergy tests at an early stage if re-operation cannot be delayed. In such cases, skin test results alone should not be used to guide subsequent anesthesia management to avoid recurrent anaphylaxis.

show abstract

Usefulness of Basophil Activation Tests for Diagnosis of Sugammadex-Induced Anaphylaxis

Abstract: The BAT seems to have comparable accuracy to skin tests for the diagnosis of sugammadex-induced anaphylaxis. For this purpose, both CD203c and CD63 can be used to detect activated basophils.

Cited by 27 publications

References 29 publications

Comparison of incidence of anaphylaxis between sugammadex and neostigmine: a retrospective multicentre observational study

Comparison of incidence of anaphylaxis between sugammadex and neostigmine: a retrospective multicentre observational study

Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report

Interpreting the results of early skin tests after perioperative anaphylaxis requires special attention: a case report and review of literature

Contact Info

Product

Resources

About