Saturday, 17 October 2015
Hall D1 Foyer (Floor 3) (Coex Convention Center)
Joo-Hee Kim, MD
,
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
Young-Sook Jang, Msc
,
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
Jeong-Hee Choi, MD, PhD
,
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
Sunghoon Park, MD, PhD
,
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
Young Il Hwang, MD, PhD
,
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
Seung Hun Jang, MD, PhD
,
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
Ki-Suck Jung, MD, PhD
,
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
Background: Diagnostic work-up in patients suffering life-threatening drug anaphylaxis is difficult in clinical practice owing to the low sensitivity of the laboratory tests and the risk of anaphylaxis using in vivo tests. Flow cytometry-assisted basophil activation test (BAT) is suggested a safe diagnostic method, although it is more expensive and technically challenging compared to conventional
in vitro or
in vivo tests. We sought to evaluate the diagnostic utility of this testing in clinical practice.
Method: Nineteen patients with a drug-induced anaphylaxis were recruited. Basophil activation test, skin tests, and measurement of commercially available specific IgE to drugs were performed for diagnostic evaluation. A stimulation index≥2 and an absolute activated basophil percentage≥5 were considered positive response to BAT.
Results: All patients met the FAAN/NIAID criteria for anaphylaxis. Causality assessment using the WHO-UMC classified them into the categories ‘certain’ or ‘probable’. Male to female ratio was 1:1.1 and the mean age was 46.0 ± 12.0 yrs. Five patients presented severe anaphyalxis such as hypotension, hypoxia or loss of consciousness, and the others were moderate severity. The involved drugs were cephalosporin antibiotics in 9 patients, eperisone 2, ranitidine 3, and aminoglycoside, glimepiride, humalog insulin, paclitaxel, tradamol, propofol in one patient each. BAT using CD 63 marker was positive in 12 (63.2%), and negative in 7 patients, whereas BAT using CD203c was positive in 9 (47.4%) and negative in 10 patients. When both markers applied, 14 patients (70.0%) showed positive to BAT. Skin test was positive in 8 (47.0%), negative in 9, and nonapplicable in two patients.
Conclusion: The BAT proves to be a useful diagnostic tool for drug-induced anaphyalxis. In addition, this test can identify the causative drug in patients with negative skin test or unavailable to sIgE measurement.
