PMID- 17667569
OWN - NLM
STAT- MEDLINE
DCOM- 20070921
LR  - 20220317
IS  - 0003-3022 (Print)
IS  - 0003-3022 (Linking)
VI  - 107
IP  - 2
DP  - 2007 Aug
TI  - Immunoglobulin E antibodies to rocuronium: a new diagnostic tool.
PG  - 253-9
AB  - BACKGROUND: Diagnosis of allergy from neuromuscular blocking agents is not always 
      straightforward. The objectives of the current study were to investigate the 
      value of quantification of immunoglobulin E (IgE) by ImmunoCAP (Phadia AB, 
      Uppsala, Sweden) in the diagnosis of rocuronium allergy and to study whether IgE 
      inhibition tests can predict clinical cross-reactivity between neuromuscular 
      blocking agents. METHODS: Twenty-five rocuronium-allergic patients and 30 control 
      individuals exposed to rocuronium during uneventful anesthesia were included. 
      Thirty-two sera (total IgE > 1,500 kU/l) were analyzed for potential interference 
      of elevated total IgE titers. Results were compared with quantification of IgE 
      for suxamethonium, morphine, and pholcodine. Cross-reactivity between drugs was 
      assessed by IgE inhibition and skin tests. RESULTS: Sensitivity of IgE for 
      rocuronium, suxamethonium, morphine, and pholcodine was 68, 60, 88, and 86%, 
      respectively. Specificity was 100% for suxamethonium, morphine, and pholcodine 
      IgE and 93% for rocuronium IgE. ROC analysis between patients and control 
      individuals changed the threshold to 0.13 kUa/l for rocuronium, 0.11 kUa/l for 
      suxamethonium, 0.36 kUa/l for morphine, and 0.43 kUa/l for pholcodine. 
      Corresponding sensitivity was 92, 72, 88, and 86%, respectively. Specificity was 
      unaltered. Interference of elevated total IgE with quantification of IgE was 
      demonstrated by the analysis in sera with a total IgE greater than 1,500 kU/l. 
      IgE inhibition did not predict clinical relevant cross-reactivity. CONCLUSIONS: 
      The rocuronium ImmunoCAP constitutes a reliable technique to diagnose rocuronium 
      allergy, provided an assay-specific decision threshold is applied. IgE assays 
      based on compounds bearing ammonium epitopes are confirmed to represent reliable 
      tools to diagnose rocuronium allergy. High total IgE titers were observed to 
      affect specificity of the assays.
FAU - Ebo, Didier G
AU  - Ebo DG
AD  - Department of Immunology-Allergology, University of Antwerp, Belgium. 
      immuno@ua.ac.be
FAU - Venemalm, Lennart
AU  - Venemalm L
FAU - Bridts, Chris H
AU  - Bridts CH
FAU - Degerbeck, Frederik
AU  - Degerbeck F
FAU - Hagberg, Hans
AU  - Hagberg H
FAU - De Clerck, Luc S
AU  - De Clerck LS
FAU - Stevens, Wim J
AU  - Stevens WJ
LA  - eng
PT  - Comparative Study
PT  - Controlled Clinical Trial
PT  - Journal Article
PL  - United States
TA  - Anesthesiology
JT  - Anesthesiology
JID - 1300217
RN  - 0 (Analgesics)
RN  - 0 (Androstanols)
RN  - 0 (Antibodies, Anti-Idiotypic)
RN  - 0 (Morpholines)
RN  - 0 (Narcotics)
RN  - 0 (Neuromuscular Depolarizing Agents)
RN  - 0 (Neuromuscular Nondepolarizing Agents)
RN  - 37341-29-0 (Immunoglobulin E)
RN  - 76I7G6D29C (Morphine)
RN  - J2R869A8YF (Succinylcholine)
RN  - LPP64AWZ7L (pholcodine)
RN  - UX6OWY2V7J (Codeine)
RN  - WRE554RFEZ (Rocuronium)
SB  - IM
MH  - Analgesics/immunology
MH  - Androstanols/administration & dosage/adverse effects/*immunology
MH  - Antibodies, Anti-Idiotypic/*blood/immunology
MH  - Antibody Specificity
MH  - Codeine/analogs & derivatives/immunology
MH  - Cross Reactions/immunology
MH  - Drug Hypersensitivity/*diagnosis/immunology
MH  - Humans
MH  - Immunoglobulin E/*blood/*immunology
MH  - Morphine/immunology
MH  - Morpholines/immunology
MH  - Narcotics/immunology
MH  - Neuromuscular Depolarizing Agents/immunology
MH  - Neuromuscular Nondepolarizing Agents/administration & dosage/adverse 
      effects/*immunology
MH  - ROC Curve
MH  - Reference Values
MH  - Rocuronium
MH  - Sensitivity and Specificity
MH  - Skin Tests/methods
MH  - Succinylcholine/immunology
EDAT- 2007/08/02 09:00
MHDA- 2007/09/22 09:00
CRDT- 2007/08/02 09:00
PHST- 2007/08/02 09:00 [pubmed]
PHST- 2007/09/22 09:00 [medline]
PHST- 2007/08/02 09:00 [entrez]
AID - 00000542-200708000-00012 [pii]
AID - 10.1097/01.anes.0000270735.40872.f2 [doi]
PST - ppublish
SO  - Anesthesiology. 2007 Aug;107(2):253-9. doi: 10.1097/01.anes.0000270735.40872.f2.