Place du test d’activation des basophiles dans le diagnostic de l’allergie aux curares. Étude immunologique multicentrique

IF 0.3 4区医学 Revue Francaise d Allergologie Pub Date : 2024-10-19 DOI:10.1016/j.reval.2024.104171

J. Sainte-Laudy , M. Cogné , J. Goret , J.C. Lecron , G. Kanny , T. Tabary , O. Barbier , E. Bellet , S. Guez , F. Lavaud , Y. Meunier , P.M. Mertes , C. Mouton , R. Stenger , F. Touraine

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Abstract

Aim of the study

Evaluation of the diagnostic value of the basophil activation test (BAT) by flow cytometry in allergy to neuromuscular blocking agents (NMBA).

Patients and methods

One hundred and twenty-one patients older than 18 having experienced a grade II to IV peranesthetic shock were included in nine French hospitals. The final conclusion of the allegro-anesthesiologist was based on clinical and biological data and on skin tests, representing the “gold standard” of muscle relaxant agent's allergy diagnosis. The most frequently used NMBAs were suxamethonium, rocuronium and atracurium. Skin tests were performed according to EAACI recommendations and BAT according to Bühmann's laboratory protocol. BAT results were expressed in percentage of basophils expressing CD63 (%CD63) and in an activation index (AI) calculated according to a specific algorithm.

Results

Out of the 100 cases included, the positive (PPV) and negative (NPV) predictive values for ST were respectively 100% and 75%. For BAT, out of 64 cases, the PPV and NPV were respectively 100% and 41% (%CD63) and 100% and 51% (AI). The khi² test calculated between ST and BAT was statistically significant (P < 0.001) for suxamethonium and rocuronium. Using a threshold of 2 kUA/L (threshold corresponding to 100% specificity), the PPV and NPV of morphine specific IgEs were respectively 100% and 27%. Cross-reactions observed by TC and TAB for benzylisoquinolinium and aminosteroid compound groups were not significantly different.

Conclusion

The ST characteristics observed in this study are consistent with literature data with a lower NPV but a high PPV for BAT authorizing its use for diagnosis and selection of a negative NMBA with a view to subsequent intervention concerning a patient allergic to an NMBA. Its sensitivity is, however, lower than for TC but may be improved by the simultaneous use of an early activation marker as the membrane IgE.

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嗜碱性粒细胞活化试验在箭毒过敏诊断中的地位。多中心免疫学研究

研究目的通过流式细胞术评估嗜碱性粒细胞活化试验（BAT）对神经肌肉阻滞剂（NMBA）过敏的诊断价值。患者和方法纳入了法国九家医院的 121 名 18 岁以上、经历过 II 至 IV 级麻醉休克的患者。麻醉科医生根据临床和生物学数据以及皮试得出最终结论，皮试是诊断肌肉松弛剂过敏的 "金标准"。最常用的 NMBAs 是舒喘宁、罗库铵和阿曲库铵。皮试根据 EAACI 建议进行，BAT 根据 Bühmann 实验室方案进行。结果在纳入的 100 个病例中，ST 的阳性预测值（PPV）和阴性预测值（NPV）分别为 100%和 75%。在 64 个病例中，BAT 的 PPV 和 NPV 分别为 100%和 41%（%CD63）以及 100%和 51%（AI）。计算出的 ST 和 BAT 之间的 khi2 检验结果显示，舒血宁和罗库溴铵具有统计学意义（P < 0.001）。以 2 kUA/L（特异性为 100%）为阈值，吗啡特异性 IgE 的 PPV 和 NPV 分别为 100%和 27%。本研究中观察到的 ST 特性与文献数据一致，BAT 的 NPV 较低，但 PPV 较高，可用于诊断和选择阴性 NMBA，以便对 NMBA 过敏患者进行后续干预。不过，其灵敏度低于 TC，但同时使用膜 IgE 等早期活化标记物可提高灵敏度。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Revue Francaise d Allergologie Medicine-Immunology and Allergy

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33.30%

发文量

349

期刊介绍： La Revue Française d''Allergologie : un véritable forum pour faire connaître des travaux originaux et permettre la diffusion de l''information auprès de toutes les spécialités concernées par les pathologies allergiques. La Revue Française d''Allergologie (8 numéros par an) est au carrefour de nombreuses spécialités - dermatologie, pédiatrie, ORL, pneumologie, ophtalmologie, médecine interne - qui, toutes, ont à traiter des maladies allergiques. Les symptômes des allergies fondés sur des mécanismes communs sont le plus souvent associés et se succèdent chez un même patient. En forte progression depuis 20 ans, les maladies allergiques sont dans l''attente de perfectionnements et d''avancées thérapeutiques qui permettront aux nombreux patients qui en sont atteints de mieux vivre avec leurs allergies. La Revue Française d''Allergologie se veut donc un véritable forum de discussions et d''échanges entre tous les spécialistes confrontés aux pathologies

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