TY - JOUR
T1 - In vitro diagnostic tests for perioperative hypersensitivity, a narrative review
T2 - potential, limitations, and perspectives
AU - Takazawa, Tomonori
AU - Sabato, Vito
AU - Ebo, Didier G.
N1 - Publisher Copyright:
© 2019 British Journal of Anaesthesia
PY - 2019/7
Y1 - 2019/7
N2 - Correct diagnostic management of perioperative hypersensitivity aims to identify the underlying mechanism(s), responsible culprit(s), and safe alternative drugs or techniques. Although drug provocation tests are considered the gold standard, diagnosis of perioperative hypersensitivity mainly relies on skin testing. Use of in vitro tests, such as quantification of specific immunoglobulin E antibodies, serum tryptase, and plasma histamine, as well as basophil activation tests is becoming widespread. These latter tests have the advantage of having no risk of recurrence of immediate hypersensitivity reactions. In this narrative review, we summarise the principles of these in vitro tests, and the possibilities and limitations when these tests are used for testing sensitivity to substances with a high risk of causing perioperative hypersensitivity. Hence, we focus on neuromuscular blocking agents, antibiotics, natural rubber latex, and opiates/opioids. The combination of multiple tests would allow diagnosis of perioperative hypersensitivity with the right balance of safety and accuracy.
AB - Correct diagnostic management of perioperative hypersensitivity aims to identify the underlying mechanism(s), responsible culprit(s), and safe alternative drugs or techniques. Although drug provocation tests are considered the gold standard, diagnosis of perioperative hypersensitivity mainly relies on skin testing. Use of in vitro tests, such as quantification of specific immunoglobulin E antibodies, serum tryptase, and plasma histamine, as well as basophil activation tests is becoming widespread. These latter tests have the advantage of having no risk of recurrence of immediate hypersensitivity reactions. In this narrative review, we summarise the principles of these in vitro tests, and the possibilities and limitations when these tests are used for testing sensitivity to substances with a high risk of causing perioperative hypersensitivity. Hence, we focus on neuromuscular blocking agents, antibiotics, natural rubber latex, and opiates/opioids. The combination of multiple tests would allow diagnosis of perioperative hypersensitivity with the right balance of safety and accuracy.
KW - allergy
KW - anaesthesia
KW - anaphylaxis
KW - basophil activation test
KW - hypersensitivity
KW - perioperative
KW - skin test
KW - specific IgE
UR - http://www.scopus.com/inward/record.url?scp=85061300247&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2019.01.002
DO - 10.1016/j.bja.2019.01.002
M3 - 総説
C2 - 30915999
AN - SCOPUS:85061300247
SN - 0007-0912
VL - 123
SP - e117-e125
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 1
ER -