PMID- 21169794
OWN - NLM
STAT- MEDLINE
DCOM- 20110127
LR  - 20191210
IS  - 1528-1175 (Electronic)
IS  - 0003-3022 (Linking)
VI  - 114
IP  - 1
DP  - 2011 Jan
TI  - Evaluation of a new routine diagnostic test for immunoglobulin E sensitization to 
      neuromuscular blocking agents.
PG  - 91-7
LID - 10.1097/ALN.0b013e31820164d2 [doi]
AB  - BACKGROUND: Neuromuscular blocking agents (NMBA) are responsible for most 
      immediate hypersensitivity reactions during anesthesia, as a result of the 
      presence of a quaternary ammonium ion. The aim of this study was to evaluate the 
      diagnostic performance of a commercial immunoglobulin E (IgE) test (quaternary 
      ammonium morphine [QAM]) for diagnosing sensitivity to NMBA. METHODS: We tested 
      168 patients exposed to NMBAs during anesthesia. Of those patients, 54 had an 
      uneventful procedure and 114 had immediate hypersensitivity reactions, and 57 
      patients had positive skin tests to the administered NMBA, whereas 57 had 
      negative skin tests. Specific IgE concentrations determined with the QAM method 
      based on a morphine solid phase were compared with those obtained with a 
      recommended experimental method with a choline solid phase. RESULTS: For the QAM 
      test, a 0.35 kUA/l positivity cutoff was chosen from the receiver operating 
      characteristics curve. QAM-specific IgE was found in 84.2% of skin test-positive 
      reactors (80.7% with the recommended method; no significant difference), and 
      binding was inhibited by the culprit NMBA in 80% of cases. The frequency of 
      QAM-specific IgE positivity was significantly higher in skin test-negative 
      reactors (24.6%) than in controls (9.3%), suggesting NMBA sensitivity. 
      CONCLUSION: Sensitivity of the QAM test (84.2%), together with its simplicity and 
      suitability for routine laboratory use, makes it a valuable tool, in conjunction 
      with skin tests, for diagnosing NMBA sensitivity in patients who react after NMBA 
      injection. The QAM test is of particular interest when skin tests are not 
      available or not reliable or give results poorly compatible with mediator release 
      or clinical features.
FAU - Laroche, Dominique
AU  - Laroche D
AD  - Service de Biophysique, Centre Hospitalier Universitaire, Caen, France. 
      laroche-do@chu-caen.fr
FAU - Chollet-Martin, Sylvie
AU  - Chollet-Martin S
FAU - Leturgie, Pierre
AU  - Leturgie P
FAU - Malzac, Laure
AU  - Malzac L
FAU - Vergnaud, Marie-Claude
AU  - Vergnaud MC
FAU - Neukirch, Catherine
AU  - Neukirch C
FAU - Venemalm, Lennart
AU  - Venemalm L
FAU - Gueant, Jean-Louis
AU  - Gueant JL
FAU - Nicaise Roland, Pascale
AU  - Nicaise Roland P
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Anesthesiology
JT  - Anesthesiology
JID - 1300217
RN  - 0 (Neuromuscular Blocking Agents)
RN  - 0 (Quaternary Ammonium Compounds)
RN  - 37341-29-0 (Immunoglobulin E)
RN  - 76I7G6D29C (Morphine)
SB  - IM
CIN - Anesthesiology. 2011 Sep;115(3):657-9; author reply 659-60. PMID: 21862892
MH  - Drug Hypersensitivity/blood/*diagnosis/etiology
MH  - Female
MH  - Humans
MH  - Hypersensitivity, Immediate/blood/chemically induced/*diagnosis
MH  - Immunoglobulin E/blood/*immunology
MH  - Male
MH  - Middle Aged
MH  - Morphine/immunology
MH  - Neuromuscular Blocking Agents/*adverse effects/immunology
MH  - Quaternary Ammonium Compounds/immunology
MH  - ROC Curve
MH  - Reproducibility of Results
MH  - Retrospective Studies
MH  - Sensitivity and Specificity
MH  - Skin Tests/methods/statistics & numerical data
EDAT- 2010/12/21 06:00
MHDA- 2011/01/29 06:00
CRDT- 2010/12/21 06:00
PHST- 2010/12/21 06:00 [entrez]
PHST- 2010/12/21 06:00 [pubmed]
PHST- 2011/01/29 06:00 [medline]
AID - 10.1097/ALN.0b013e31820164d2 [doi]
PST - ppublish
SO  - Anesthesiology. 2011 Jan;114(1):91-7. doi: 10.1097/ALN.0b013e31820164d2.