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1. Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study

Author

Olivier Clement, Pascale Dewachter, Claudie Mouton-Faivre, Camille Nevoret, Laurence Guilloux, Evelyne Bloch Morot, Sandrine Katsahian, Dominique Laroche, Martine Audebert, Béatrice Benabes-Jezraoui, Yves Benoit, Sylvie Beot, Frédéric Berard, Yves Berthezene, Philippe Bertrand, Juliette Bouffard, Jean-Luc Bourrain, Bruno Boyer, Marie-France Carette, Christine Caron-Poitreau, Béatrice Cavestri, Jean Pierre Cercueil, Denis-André Charpin, Evelyne Collet, Arielle Crombe-Ternamian, Jacques Dalmas, Eric Decoux, Marie-France Defrance, Yvonne Delaval, Pascal Demoly, Claude Depriester, Pascale Depriester, Alain Didier, Martine Drouet, Benoît Dupas, Dominique Dupre-Goetchebeur, Charles Dzviga, Christine Fabre, Gilbert Ferretti, Corinne Fourre-Jullian, Pascal Girardin, Jacques Giron, Marion Gouitaa, Nicolas Grenier, Lydie Guenard Bilbault, Stéphane Guez, Nathalie Gunera-Saad, Jean-François Heautot, Dominique Herbin, Cyrille Hoarau, Claude Jacquot, Christian Julien, Laurent Laborie, Claude Lambert, Pascal Larroche, Xavier Leclerc, Laurent Lemaitre, Francisque Leynadier, Agnès Lillo-Le-Louet, Jean-Pierre Louvel, Nathalie Louvier, Marie-Madeleine Lucas, Geneviève Meites, Nicolas Mennesson, Liliane Metge, Yannick Meunier, Laurence Monnier-Cholley, Mariano Musacchio, Brigitte Nicolie, Gisèle Occelli, Hélène Oesterle, Francine Paisant-Thouveny, Michel Panuel, Nadine Railhac, Frédérique Rety-Jacob, Cécile Rochefort-Morel, Catherine Roy, Philippe Sarlieve, Musa Sesay, Catherine Sgro, Patrice Taourel, Patrick Terrier, Odile Theissen, Ingrid Topenot, Jocelyne Valfrey, Francis Veillon, Marie-Claude Vergnaud, Charles Veyret, Denis Vincent, Benoit Wallaert, François Wessel, and Marc Zins

Subjects
Medicine (General), R5-920
Abstract

Background: Iodinated and gadolinium-based contrast media (ICM; GBCM) induce immediate hypersensitivity (IH) reactions. Differentiating allergic from non-allergic IH is crucial; allergy contraindicates the culprit agent for life. We studied frequency of allergic IH among ICM or GBCM reactors. Methods: Patients were recruited in 31 hospitals between 2005 and 2009. Clinical symptoms, plasma histamine and tryptase concentrations and skin tests were recorded. Allergic IH was diagnosed by intradermal tests (IDT) with the culprit CM diluted 1:10, “potentially allergic” IH by positive IDT with pure CM, and non-allergic IH by negative IDT. Findings: Among 245 skin-tested patients (ICM = 209; GBCM = 36), allergic IH to ICM was identified in 41 (19.6%) and to GBCM in 10 (27.8%). Skin cross-reactivity was observed in 11 patients with ICM (26.8%) and 5 with GBCM (50%). Allergy frequency increased with clinical severity and histamine and tryptase concentrations (p 50% of life-threatening ones. GBCM and ICM triggered comparable IH reactions in frequency and severity. Cross-reactivity was frequent, especially for GBCM. We propose considering skin testing with pure contrast agent, as it is more sensitive than the usual 1:10 dilution criteria.

Published
2018
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3. Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study

Author

Dominique Herbin, Jacques Dalmas, Frédéric Berard, Jean-Luc Bourrain, Laurence Monnier-Cholley, Laurent Lemaitre, P. Girardin, Agnès Lillo-Le-Louet, Christian Julien, Lydie Guenard Bilbault, François Wessel, Jean Pierre Cercueil, Charles Veyret, Yvonne Delaval, Hélène Oesterle, Liliane Metge, Sylvie Beot, Béatrice Cavestri, Laurent Laborie, Philippe Bertrand, Arielle Crombe-Ternamian, Evelyne Collet, Evelyne Bloch Morot, Nicolas Mennesson, Claude Jacquot, Francis Veillon, Ingrid Topenot, Christine Caron-Poitreau, Brigitte Nicolie, Olivier Clément, Marie-Madeleine Lucas, Martine Audebert, Christine Fabre, Musa Sesay, Jacques Giron, Frédérique Rety-Jacob, Geneviève Meites, Francisque Leynadier, Xavier Leclerc, Pascal Larroche, Catherine Sgro, Claude Depriester, Alain Didier, Laurence Guilloux, Francine Paisant-Thouveny, Gisèle Occelli, Philippe Sarlieve, Sandrine Katsahian, Juliette Bouffard, Stéphane Guez, D. Laroche, Jean-Pierre Louvel, Corinne Fourre-Jullian, Claude Lambert, Yves Berthezene, Denis Vincent, Nicolas Grenier, Charles Dzviga, Cécile Rochefort-Morel, Yannick Meunier, Marie-France Defrance, Odile Theissen, Pascal Demoly, Michel Panuel, Eric Decoux, Cyrille Hoarau, Béatrice Benabes-Jezraoui, Marie-France Carette, Mariano Musacchio, Jean-François Heautot, Benoît Dupas, Benoit Wallaert, Denis-André Charpin, Gilbert Ferretti, Camille Nevoret, Pascale Dewachter, Marion Gouitaa, Patrice Taourel, Pascale Depriester, Yves Benoit, Bruno Boyer, Jocelyne Valfrey, Nadine Railhac, Martine Drouet, Nathalie Louvier, Claudie Mouton-Faivre, Catherine Roy, Marie-Claude Vergnaud, Nathalie Gunera-Saad, Marc Zins, Patrick Terrier, Dominique Dupre-Goetchebeur, Service de Radiologie [CHU HEGP], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Biomnis Laboratory, Service de Médecine Interne [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Centre de référence des syndromes drépanocytaires majeurs, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), CHU Amiens-Picardie, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Service d'immunologie [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Hôpital de la Croix-Rousse [CHU - HCL], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Grenoble, Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), UNICANCER, Service de dermatologie et allergologie [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hôpital Albert Calmette, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de radiologie et d'Imagerie médicale diagnostique et thérapeutique (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Hôpital Nord [CHU - APHM], Service de Dermatologie (CHU de Dijon), CH Martigues, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre hospitalier Saint-Joseph [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pontchaillou [Rennes], Université de Montpellier (UM), Service de pneumologie [Toulouse], CHU Toulouse [Toulouse]-Hôpital Larrey [Toulouse], CHU Toulouse [Toulouse], Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Morvan - CHRU de Brest (CHU - BREST ), Service de radiologie [Saint-Etienne], CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Service central de radiologie et d'imagerie médicale, CHU Grenoble-Hôpital Michallon, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Hôpital Purpan [Toulouse], Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], Centre Hospitalier Public du Cotentin (CHPC), Service de néphrologie et immunologie clinique [CHRU Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT), Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, CHU Saint-Etienne, Département de radiologie [Brest] (DR - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Services de neuroradiologie [Lille], Hôpital Roger Salengro [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Claude Huriez [Lille], CHU Lille, Service de Radiologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), Hôpital de Rangueil, Service de réanimation médicale [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service de Radiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Hôpital pasteur [Colmar], Centre Hospitalier Universitaire de Nice (CHU Nice), CHU Strasbourg, Laboratoire de Pharmacologie-Toxicologie [CHU de Dijon], Service de pneumologie, allergologie, mucoviscidose pédiatrique [Rouen], Service de radiologie [Strasbourg], CHU Strasbourg-Hôpital de Hautepierre [Strasbourg], Service de Médecine générale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de pneumologie [Nantes], Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Groupe hospitalier Paris Saint-Joseph - Hôpital, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Service de radiologie et imagerie médicale [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre Hospitalier Public du Cotentin [Cherbourg-Octeville] (CHPC), Service de Néphrologie et d’Immunologie Clinique [CHRU Tours], Hôpital Bretonneau-Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Hôpital Jean Minjoz, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Sorbonne Université, Herrada, Anthony, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Saint-Etienne-Université Jean Monnet - Saint-Étienne (UJM), Institut des Neurosciences de Montpellier (INM), CH Centre Hospitalier Public du Cotentin (CHPC), Hôpital Charles Nicolle [Rouen], Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Centre de référence des syndromes drépanocytaires majeurs-Hôpital Européen Georges Pompidou [APHP] (HEGP), Service de néphrologie et immunologie clinique [CHRU Tours] (EA4245 UT), and Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours

Subjects
medicine.medical_specialty, Allergy, Tryptase, Gastroenterology, Culprit, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, medicine, Clinical severity, lcsh:R5-920, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, biology, business.industry, General Medicine, medicine.disease, 3. Good health, 030228 respiratory system, chemistry, biology.protein, Intradermal test, Plasma histamine, lcsh:Medicine (General), business, Histamine, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Research Paper
Abstract

International audience; Background:Iodinated and gadolinium-based contrast media (ICM; GBCM) induce immediate hypersensitivity (IH) reactions. Differentiating allergic from non-allergic IH is crucial; allergy contraindicates the culprit agent for life. We studied frequency of allergic IH among ICM or GBCM reactors.Methods:Patients were recruited in 31 hospitals between 2005 and 2009. Clinical symptoms, plasma histamine and tryptase concentrations and skin tests were recorded. Allergic IH was diagnosed by intradermal tests (IDT) with the culprit CM diluted 1:10, "potentially allergic" IH by positive IDT with pure CM, and non-allergic IH by negative IDT.Findings:Among 245 skin-tested patients (ICM = 209; GBCM = 36), allergic IH to ICM was identified in 41 (19.6%) and to GBCM in 10 (27.8%). Skin cross-reactivity was observed in 11 patients with ICM (26.8%) and 5 with GBCM (50%). Allergy frequency increased with clinical severity and histamine and tryptase concentrations (p 50% of life-threatening ones. GBCM and ICM triggered comparable IH reactions in frequency and severity. Cross-reactivity was frequent, especially for GBCM. We propose considering skin testing with pure contrast agent, as it is more sensitive than the usual 1:10 dilution criteria.

Published
2018

4. Evaluation of a New Routine Diagnostic Test for Immunoglobulin E Sensitization to Neuromuscular Blocking Agents

Author

Catherine Neukirch, Pascale Nicaise Roland, Jean-Louis Guéant, D. Laroche, Laure Malzac, Marie-Claude Vergnaud, Lennart Venemalm, Pierre Léturgie, and Sylvie Chollet-Martin

Subjects
Hypersensitivity, Immediate, Male, Immunoglobulin E, Sensitivity and Specificity, Drug Hypersensitivity, chemistry.chemical_compound, medicine, Humans, Choline, Sensitization, Retrospective Studies, Skin Tests, Morphine, biology, Receiver operating characteristic, business.industry, Reproducibility of Results, Diagnostic test, Middle Aged, Neuromuscular Blocking Agents, Quaternary Ammonium Compounds, Anesthesiology and Pain Medicine, medicine.anatomical_structure, ROC Curve, chemistry, Anesthesia, biology.protein, Female, Antibody, business, medicine.drug
Abstract

Background Neuromuscular blocking agents (NMBA) are responsible for most immediate hypersensitivity reactions during anesthesia, as a result of the presence of a quaternary ammonium ion. The aim of this study was to evaluate the diagnostic performance of a commercial immunoglobulin E (IgE) test (quaternary ammonium morphine [QAM]) for diagnosing sensitivity to NMBA. Methods We tested 168 patients exposed to NMBAs during anesthesia. Of those patients, 54 had an uneventful procedure and 114 had immediate hypersensitivity reactions, and 57 patients had positive skin tests to the administered NMBA, whereas 57 had negative skin tests. Specific IgE concentrations determined with the QAM method based on a morphine solid phase were compared with those obtained with a recommended experimental method with a choline solid phase. Results For the QAM test, a 0.35 kUA/l positivity cutoff was chosen from the receiver operating characteristics curve. QAM-specific IgE was found in 84.2% of skin test-positive reactors (80.7% with the recommended method; no significant difference), and binding was inhibited by the culprit NMBA in 80% of cases. The frequency of QAM-specific IgE positivity was significantly higher in skin test-negative reactors (24.6%) than in controls (9.3%), suggesting NMBA sensitivity. Conclusion Sensitivity of the QAM test (84.2%), together with its simplicity and suitability for routine laboratory use, makes it a valuable tool, in conjunction with skin tests, for diagnosing NMBA sensitivity in patients who react after NMBA injection. The QAM test is of particular interest when skin tests are not available or not reliable or give results poorly compatible with mediator release or clinical features.

Published
2011

5. Case Report about Fatal or Near-Fatal Hypersensitivity Reactions to Cetuximab: Anticetuximab IgE as a Valuable Screening Test

Author

D. Laroche, Cristian Moldovan, Jean-Michel Grellard, Benoît Dupont, Radj Gervais, Delphine Mariotte, and Marie-Claude Vergnaud

Subjects
Screening test, Side effect, neoplasms, Case Report, Disease, Immunoglobulin E, lcsh:RC254-282, cetuximab, medicine, anaphylaxis, biology, Cetuximab, business.industry, Cancer, medicine.disease, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, digestive system diseases, antidrug IgE, Oncology, Immunology, biology.protein, Antibody, hypersensitivity, business, Anaphylaxis, medicine.drug
Abstract

Hypersensitivity reactions are a classic side effect of cetuximab. We report the cases of three patients who developed life-threatening hypersensitivity to cetuximab, which could have been predicted by assessing the concentration of serum anticetuximab immunoglobulin (Ig)E. The anti-cetuximab IgE concentration could be an interesting test to predict which patients are at risk of experiencing severe hypersensitivity reactions to cetuximab.

Published
2014

6. Immediate reactions following iodinated contrast media injection: a study of 38 cases

Author

Olivier Clément, Claudie Mouton-Faivre, Evelyne Bloch-Morot, Jean-Pierre Cercueil, Liliane Metge, Marie-Claude Vergnaud, Marie-France Carette, Pascale Dewachter, and D. Laroche

Subjects
Adult, Male, medicine.medical_specialty, Allergy, Adolescent, Contrast Media, Tryptase, Culprit, Gastroenterology, chemistry.chemical_compound, Young Adult, Iodinated contrast, Internal medicine, Immunopathology, medicine, Humans, Radiology, Nuclear Medicine and imaging, Young adult, Anaphylaxis, Aged, biology, business.industry, General Medicine, Middle Aged, medicine.disease, Surgery, chemistry, Injections, Intra-Arterial, biology.protein, Female, Drug Eruptions, business, Histamine, Iodine
Abstract

Objectives To investigate the pathomechanisms involved in cases of immediate hypersensitivity reactions occurring after the administration of iodinated contrast media. Materials and methods Patients having presented clinical signs of immediate hypersensitivity suggesting allergy after iodinated contrast medium were investigated. Histamine and tryptase concentrations were measured, and/or skin tests were performed. Patients with positive skin tests to the culprit contrast agent were classified as IgE-mediated allergic hypersensitivity (Group I) and patients with negative skin tests as non-allergic hypersensitivity (Group II). Results 38 patients were included. Most reactions appeared after non-ionic (n = 32). Reactions were more frequently severe following ionic than non-ionic (p = 0.014). Skin testing was not performed in 11 patients. Skin tests with the culprit contrast agent were negative in 26% of the patients (Group II, n = 7) whereas they were found positive with the contrast agent in 73% of the patients (Group I, n = 19). Latex-induced reaction was diagnosed in one patient, and was consequently excluded from the cohort. In Group I, the frequency of cross-reactivity with the other commercialized iodinated contrast media was low (7%). Cardiovascular signs were present in Group I (52.6%, n = 10), and absent in Group II (p = 0.023). Histamine and tryptase concentrations were higher in patients who had cardiovascular signs (p Conclusion Immediate reactions with clinical signs suggesting allergy along with positive skin tests with the administered contrast agent confirm immediate allergic hypersensitivity (anaphylaxis) to this agent. Consequently, the culprit contrast agent should be definitely avoided as well as cross-reactive ICM in order to prevent further recurrences.

Published
2009

7. Anaphylactoid reactions to iodinated contrast media

Author

D. Laroche, Claude Lefrancois, Marie-Claude Vergnaud, Stéphane Hue, and H. Bricard

Subjects
Adult, Male, Adolescent, Iodine Compounds, Contrast Media, Tryptase, Basophil, Iodinated contrast media, chemistry.chemical_compound, Risk Factors, medicine, Humans, Radiology, Nuclear Medicine and imaging, Anaphylaxis, Sensitization, Aged, Skin Tests, biology, Mast cell activation, Middle Aged, medicine.anatomical_structure, chemistry, embryonic structures, Immunology, biology.protein, Female, Anaphylactoid reactions, Histamine
Abstract

The mechanisms of immediate reactions to iodinated contrast media (ICM) are currently debated. Most of them and especially the minor and mild ones are being attributed to a direct, non-specific effect of the molecule (1), and a smaller number of severe cases, are suspected to be anaphylactic, IgE-depending events (2). The purpose of this study was to investigate reactions occurring immediatly after ICM injection by measuring histamine and tryptase, two specific markers of basophil and/or mast cell activation. Some patients agreed to be skin-tested in order to detect a sensitization to ICM.

Published
2002

8. In Reply

Author

Dominique, Laroche, Sylvie, Chollet-Martin, Pierre, Léturgie, Laure, Malzac, Marie-Claude, Vergnaud, Catherine, Neukirch, Lennart, Venemalm, Jean-Louis, Guéant, and Pascale Nicaise, Roland

Subjects
Anesthesiology and Pain Medicine
Published
2011

9. Biochemical markers of anaphylactoid reactions to drugs. Comparison of plasma histamine and tryptase

Author

D. Laroche, Marie-Claude Vergnaud, Henri Soufarapis, Béatrice Sillard, and H. Bricard

Subjects
Drug, Adult, Allergy, medicine.drug_class, media_common.quotation_subject, Tryptase, Pharmacology, chemistry.chemical_compound, Medicine, Humans, Anaphylaxis, media_common, Aged, Aged, 80 and over, biology, business.industry, Muscle relaxant, Middle Aged, Mast cell, medicine.disease, Anesthesiology and Pain Medicine, medicine.anatomical_structure, chemistry, Immunology, Anesthetic, biology.protein, business, Histamine, Biomarkers, medicine.drug, Peptide Hydrolases
Abstract

Adverse reactions to drugs require that their mechanisms be elucidated, particularly when anaphylaxis is suspected. Early diagnosis can be achieved by plasma histamine measurements. Unfortunately, the short plasma half-life of histamine and the difficulties in handling the sample usually preclude this measurement, although a sensitive radioimmunologic kit is routinely available. It has been recently suggested that mast cell tryptase, a component of the mast cell granules, could provide an alternative to histamine determination. We have measured plasma histamine and tryptase in 19 patients who developed possible anaphylactoid reactions to anesthetic or other drugs. Eight patients had increased values for both histamine and tryptase. In 4 a muscle relaxant drug was proved responsible for the reaction. Six patients had normal levels for both substances. In each case, the clinical signs of anaphylaxis were moderate. Two patients had normal histamine and high tryptase concentrations, due to late sampling (greater than 5 h). In 2 other patients, histamine was high, with normal tryptase: in 1, muscle relaxant allergy was further demonstrated. Tryptase half-life was equal to 90 min in 3 patients. At least 15 min was necessary to reach the peak level when the responsible drug was administered intravenously. The best time for measuring tryptase was 1-2 h after the reaction (not greater than 6 h), whereas for histamine it was 10 min to 1 h. We conclude that measurement of plasma tryptase along with measurement of plasma histamine may aid in diagnosis of anaphylaxis.

Published
1991

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