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Risk factors for intraoperative immediate-type hypersensitivity reactions may require allergological evaluation. We report the case of a hairdresser with a positive history of penicillin hypersensitivity and anaphylactic shock during previous general anesthesia, whose in vivo and in vitro allergy tests were positive for neuromuscular blocking agents, opioids, and midazolam. Immediate-type hypersensitivity reactions to antibiotics and professional exposure to hairdressing products might induce simultaneous cross-sensitization to multiple drugs that are commonly used during general anesthesia.

Background: Flowcytometry-assisted basophil activation tests (BAT) are useful in vitro diagnostic tools for drug-induced immediate-type hypersensitivity. Objective: The study aimed to perform a medical literature review on the perform‐ ance of CD63 BAT. Results: Seven studies for antibiotics, eleven for neuromuscular blocking agents (NMBAs), and 10 for nonsteroidal anti-inflammatory drugs (NSAIDs) 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 BAT positivity varied from basophils in the range greater than 4–15%, a net percentage of activated baso‐ phils greater than 5% or a stimulation index ranging 1.76–1.85, to the use of more complex composite indexes for NMBAs. For antibiotics and NSAIDs, a stimulation index > 2 was generally chosen. BAT sensitivity for β-lactams was 33–55%, while specificity was 79–93.3%. For NMBAs, BAT sensitivity was 36–92%, while specificity was 93–100%. For NSAIDs, BAT sensitivity was 11.7–61% and specificity was 74–100%. Discussion: BAT for the diagnosis of drug hypersensitivity has good specificity, but only moderate sensitivity. Despite the shortcomings and the methodological differences in BAT, 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.

In vivo allergy tests and the detection of drug-specific antibodies are widely used in the diagnosis of β-lactam induced immediate-type hypersensitivity reactions. The diagnostic performance of immunoenzymatic tests for the demonstration of serum-specific IgE (IgEs) antibodies is influenced by total IgE values (IgEt). The aim of this study was to investigate whether the result obtained by radioimmunoassays (RIA) for β-lactams IgEs antibodies is correlated to IgEt.68 paired in vivo and in vitro tests were performed for the culprit drugs in 49 patients with suspected previous hypersensitivity reactions to β-lactams. 14 controls who tolerated the tested antibiotics were similarly investigated. The dosing of IgEt was performed using the Immulite Immunoassay (Siemens). We detected IgEs using a sandwich-type RIA with sepharose as solid phase (Pathologie Cellulaire et Moléculaire en Nutrition, France) and anti-IgEs I(125)-labelled antibodies (Immunotech, Czech Republic).RIA-IgEs sensitivity was 56.52% in patients with IgEt120 IU/mL and 90.90% in patients with IgEt120 IU/mL (p = 0.0052). All patients with IgEt500 IU/mL had positive RIA results. RIA-IgEs specificity was 90.90% for IgEt120 IU/mL and 66.66% for IgEt120 IU/mL. The linear equation that fits the relation between IgEt and IgEs is: IgEs = (IgEt + 81.644)/137.94, with a correlation coefficient of 0.4.Serum total IgE alter the diagnostic performance of radioimmunoassays for β-lactam specific antibody dosing. Assays for the detection of both IgEt and IgEs need to be performed for each individual investigated, retrospectively, to confirm clinical immediate-type hypersensitivity reactions.

Background Several different criteria for the positivity of the flow-assisted Basophil Activation Test (BAT) for the diagnosis of Neuromuscular Blocking Agents (NMBA) hypersensitivity reactions have been used in past studies. Our aims were to determine the threshold for BAT positivity expressed as the stimulation index (SI, calculated as the percentage of activated basophils after stimulation with NMBA divided by the number of basophils with no NMBA stimulation) and as the percentage of activated basophils, and to determine the sensitivity and specificity of BAT for NMBAs. Methods 22 consenting adult patients with previous intraanaesthetic NMBAs-related hypersensitivity reactions were tested for the culprit drug. 34 controls who tolerated NMBAs were similarly tested. BAT was performed using Flow2Cast technique and the up-regulation of the CD63 marker on the basophils was measured using Cell Quest programme (FACSCalibur Becton Dickinson, USA). Receiver operating characteristics curve (ROC) analysis was performed. Results ROC curve analysis for BAT results versus history yields a stimulation index of 1.76 as the optimal threshold, with an AUC of 0.81 (CI 95% 0.69-0.93, p 5.01%, with an AUC of 0.84 (CI 95% 0.72-0.95, p 5%) as diagnostic criteria, 15 patients had positive BAT, the overall BAT sensitivity being 68.18% (CI 95% 45.11-82.26%). None of the controls fulfilled both criteria and the specificity of the test was 100% (CI 95% 87.35-100%). Conclusions With a stimulation index ≥ 1.76 and a percentage of activated basophils > 5.01% as threshold, the performance of BAT for NMBAs yields 68.18% sensitivity and 100% specificity.

Premise şi obiective: evaluarea sensibilităţii şi specificităţii testului de activare a bazofilelor (BAT) şi a determinării anticorpilor specifici (IgE) în diagnosticul retrospectiv al hipersensibilităţii la β-lactamine folosind criterii diagnostice stabilite prin efectuarea analizei curbelor ROC (receiver operating characterisitics curve) şi prezentarea unui algoritm diagnostic cu sensibilitate maximă care să reducă numărul de pacienţi supuşi testelor de provocare. Metodă: 37 pacienţi cu hipersensibilitate de tip imediat la β-lactamine au fost testaţi in vivo şi in vitro pentru antibioticul incriminat în istoric. 31 subiecţi sănătoşi au fost testaţi similar. BAT a fost efectuat prin tehnica Flow2Cast (Bühlmann Laboratories, Switzerland). Determinarea anticorpilor IgE specifici a fost efectuată prin radio-imundozare “sandwich” (RIA) pe gel solid cu sefaroză (Pathologie Université „H. Poincare”, France). Rezultate: Analiza ROC defineşte un prag optim >1.9 pentru pozitivitatea RIA, cu sensibilitate de 70.3% şi specificitate de 90.3%. Pentru BAT, un index optim>1.97 prezintă sensibilitate de 51.4% şi specificitate de 90.3%. La 89.18% dintre pacienţi diagnosticul a fost confirmat prin utilizarea combinată a testelor cutanate şi a celor in vitro, în timp ce 10.82% dintre pacienţi au avut toate testele negative. Concluzii: RIA pare să aibă o sensibilitate superioară BAT (70.3% versus 51.4%) pentru β-lactamine. Utilizarea simultană a testelor diagnostice alergologice prezintă sensibilitate de 89.18%. Sumarea testelor cutanate cu detectarea anticorpilor specifici, urmate de BAT, este o secvenţă potrivită pentru diagnosticul reacţiilor de hipersensibilitate induse de β-lactamine, niciun test diagnostic prezentând acurateţe perfectă.

Este cunoscut faptul că infecţia cu virus hepatitic C reprezintă un factor de risc pentru limfoamele non- Hodgkin cu celule B. Studiile referitoare la prevalenţa acesteia în limfoame raportează rezultate contradictorii, în funcţie de zona geografică. Limfocitoza monoclonală B este o condiţie asimptomatică care se poate transforma în limfom malign, caracterizată prin prezenţa unei populaţii clonale B circulante. Poate fi detectată prin citometrie în flux şi s-a demonstrat că prevalenţa ei la pacienţii cu virus hepatitic C este mai mare decât la populaţia generală. În literatură există doar câteva studii referitoare la prevalenţa limfocitozei monoclonale la pacienţii cu virus C iar în România nu a fost condus un asemenea studiu. Am efectuat un studiu prospectiv pe 50 de pacienţi cu virus hepatitic C internaţi la Institutul Regional de Gastroenterologie şi Hepatologie Prof.Dr.Octavian Fodor. Datele clinice şi de laborator au fost culese din foile de observaţie. Citometria în flux s-a efectuat în Laboratorul de Imunologie al Spitalului Judeţean de Urgenţă Cluj-Napoca. Am găsit o prevalenţă de 22% a limfocitozei monoclonale. Nu au existat diferenţe statistic semnificative între pacienţii cu şi fără limfocitoză monoclonală, cu excepţia numărului mai mic de leucocite (p=0.04) şi a ecogenicităţii hepatice mai mari (p=0.02) la cei cu monoclonalitate. Am întâlnit toate cele 3 subtipuri de limfocitoză monoclonală B. Prevalenţa ridicată la pacienţii cu virus hepatitic C susţine implicarea virusului în limfomageneză, dar sunt necesare alte studii pe viitor, care să analizeze rata de transformare în limfom la aceşti pacienţi.