DOI: 10.1097/01.SA.0000413403.84513.57
,
Issn Print: 0039-6206
Publication Date: 2012/06/01
Differentiating the Cellular and Humoral Components of Neuromuscular Blocking Agent–Induced Anaphylactic Reactions in Patients Undergoing Anaesthesia
R.C. Aalberse; I. Kleine Budde; M. Mulder; S.O. Stapel; W. Paulij; F. Leynadier; M.W. Hollmann
Excerpt
The importance of IgE antibodies to neuromuscular blocking agent (NMBA)–induced anaphylactic reactions during anesthesia is not clear. The relevance of IgE to rocuronium using an in vitro technique was investigated in serum samples from 61 patients with such reactions. Based on clinical history, allergy to NMBAs was regarded as likely in 48 patients, who were further assessed using intradermal skin tests for several commonly used NMBAs, including rocuronium, vecuronium, and succinylcholine. A rocuronium–human serum albumin (rocHSA) conjugate was coupled to a solid phase, and a radioallergosorbent test was performed to ascertain the presence of rocuronium IgE in human serum. The biological effects of patient serum NMBA-IgE on histamine release were investigated using in vitro sensitized basophils from healthy blood donors. IgE to rocuronium was found in 23 (48%) of 48 serum samples with NMBA allergy, although only 2 of these were able to sensitize basophils to release histamine in response to rocHSA. Responsiveness of IgE in the basophil test was only seen with conjugated rocHSA and not with unconjugated rocuronium or the other NMBAs studied. However, unconjugated rocuronium inhibited the histamine release brought about by rocHSA. The correlation between skin test reactivity to rocuronium and IgE to rocHSA was low. By contrast, a striking correlation was found between IgE to rocuronium and skin test reactivity to succinylcholine. The results indicate that NMBA-related anaphylaxis requires not only IgE NMBA reactivity but altered cellular reactivity in the patient as well. The latter can be demonstrated by testing basophils from the patient, a skin test with (steroidal) NMBA, or both.
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