Differentiating the cellular and humoral components of neuromuscular blocking agent-induced anaphylactic reactions in patients undergoing anaesthesia
Differentiating the cellular and humoral components of neuromuscular blocking agent-induced anaphylactic reactions in patients undergoing anaesthesia
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DOI：
10.1093/bja/aer028
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发表时间：
2011-05-01
影响因子：
9.8
通讯作者：
Hollmann, M. W.
中科院分区：
文献类型：
--
作者：
Aalberse, R. C.;Budde, I. Kleine;Hollmann, M. W.
背景。在麻醉期间，IgE抗体对神经肌肉阻滞剂（NMBA）诱导的过敏反应的意义尚不清楚。我们采用体外技术研究了IgE与罗库溴铵的相关性。对61例麻醉期间发生过敏反应的患者的血清样本进行了分析。根据临床病史，48例患者被认为可能对NMBA过敏，并通过皮内皮肤试验对几种常用的NMBA进行进一步评估，包括罗库溴铵、维库溴铵和琥珀酰胆碱。为了确定人血清中罗库溴铵IgE的存在，将罗库溴铵-人血清白蛋白（rocHSA）偶联物偶联到固相并进行放射过敏吸收试验。采用健康献血者体外增敏的嗜碱性粒细胞，研究了患者血清NMBA-IgE对组胺释放的生物学效应。48例NMBA过敏的血清样本中有23例（48%）发现罗库溴铵的IgE，尽管其中只有两例能够使嗜碱性细胞对rocHSA敏感，释放组胺。在嗜碱性粒细胞试验中，仅观察到偶联罗库溴铵的ige反应性，而未观察到未偶联罗库溴铵或其他NMBAs的反应性。而未偶联的罗库溴铵对rocHSA诱导的组胺释放有抑制作用。皮肤试验对罗库溴铵的反应性与IgE对rocHSA的相关性较低（P < 0.01）。相反，罗库溴铵的IgE与皮肤试验对琥珀胆碱的反应性有显著相关性（P < 0.001）。我们的研究结果表明，NMBA相关的过敏反应不仅需要IgE NMBA反应性，还需要患者细胞反应性的改变。后者可通过检测患者的嗜碱性粒细胞、（类固醇）NMBA皮肤试验或两者兼而有之来证实。
Background. The significance of IgE antibodies to neuromuscular blocking agent (NMBA)-induced anaphylactic reactions during anaesthesia is unclear. We investigated the relevance of IgE to rocuronium using an in vitro technique.Methods. Serum samples from 61 patients with anaphylactic reactions during anaesthesia were investigated. On the basis of clinical history, allergy to NMBA was considered likely in 48 patients, further assessed using intradermal skin tests for several commonly used NMBAs, including rocuronium, vecuronium, and succinylcholine. To determine the presence of rocuronium IgE in human serum, a rocuronium-human serum albumin (rocHSA) conjugate was coupled to a solid phase and a radioallergosorbent test performed. The biological effects of patient serum NMBA-IgE on histamine release were investigated using in vitro sensitized basophils from healthy blood donors.Results. IgE to rocuronium was found in 23 of 48 serum samples (48%) with NMBA allergy, although only two of these were able to sensitize basophils to release histamine in response to rocHSA. IgE-responsiveness in the basophil test was only observed with conjugated rocHSA and not with unconjugated rocuronium or the other NMBAs evaluated. However, unconjugated rocuronium inhibited the histamine release induced by rocHSA. Correlation between skin-test reactivity to rocuronium and IgE to rocHSA was low (P > 0.1). In contrast, striking correlation between IgE to rocuronium and skin-test reactivity to succinylcholine was found (P < 0.001).Conclusions. Our results indicate that NMBA-related anaphylaxis requires not only IgE NMBA reactivity, but also altered cellular reactivity in the patient. The latter may be demonstrable by testing basophils from the patient, a skin test with (steroidal) NMBA, or both.