PMID- 32709306
OWN - NLM
STAT- MEDLINE
DCOM- 20201201
LR  - 20201220
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Linking)
VI  - 125
IP  - 6
DP  - 2020 Dec
TI  - Mast cell activation test in chlorhexidine allergy: a proof of concept.
PG  - 970-975
LID - S0007-0912(20)30482-7 [pii]
LID - 10.1016/j.bja.2020.06.024 [doi]
AB  - BACKGROUND: Immediate drug hypersensitivity reactions are an increasing public 
      health issue and a frequent cause of life-threatening anaphylaxis. Conventional 
      confirmatory testing include skin tests and, for a few drugs, quantification of 
      drug-specific immunoglobulin E (IgE) antibodies. However, none of these tests are 
      absolutely predictive for the clinical outcome, and can yield false-negative and 
      false-positive results. We performed a proof-of-concept study to assess whether a 
      mast cell activation test could improve diagnosis of IgE-mediated chlorhexidine 
      hypersensitivity, a common cause of perioperative anaphylaxis. METHODS: Human 
      mast cells were generated from CD34(+) progenitor cells and sensitised with 
      patients' sera to become IgE+ human mast cells (dMC(IgE+)), and then incubated 
      with chlorhexidine to assess degranulation. We compared the diagnostic 
      performance of this mast cell activation test with serum from patients with and 
      without positive skin test and basophil activation test to chlorhexidine. 
      RESULTS: In dMC sensitised with sera from patients with a positive skin test and 
      basophil activation test to chlorhexidine showed drug-specific and 
      concentration-dependent degranulation upon stimulation with chlorhexidine, 
      determined by surface upregulation of the degranulation marker CD63. In contrast, 
      dMC sensitised with sera from patients with a negative skin test and basophil 
      activation test to chlorhexidine were unresponsive in the mast cell activation 
      test. CONCLUSIONS: Our study suggests that the mast cell activation test can be 
      used to diagnose IgE/FcepsilonRI-dependent immediate drug hypersensitivity reactions. 
      It also shows potential to assess the clinical relevance of drug-specific IgE 
      antibodies in their ability to elicit mast cell degranulation, and therefore 
      discriminate between allergy and sensitisation. Extended studies are required to 
      verify whether this technique can be used in other causes of perioperative 
      anaphylaxis.
CI  - Copyright (c) 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All 
      rights reserved.
FAU - Elst, Jessy
AU  - Elst J
AD  - Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of 
      Excellence, Faculty of Medicine and Health Sciences, University of Antwerp and 
      Antwerp University Hospital, Antwerp, Belgium.
FAU - van der Poorten, Marie-Line M
AU  - van der Poorten MM
AD  - Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of 
      Excellence, Faculty of Medicine and Health Sciences, University of Antwerp and 
      Antwerp University Hospital, Antwerp, Belgium; Department of Paediatrics, Faculty 
      of Medicine and Health Sciences, University of Antwerp and Antwerp University 
      Hospital, Antwerp, Belgium.
FAU - Faber, Margaretha A
AU  - Faber MA
AD  - Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of 
      Excellence, Faculty of Medicine and Health Sciences, University of Antwerp and 
      Antwerp University Hospital, Antwerp, Belgium.
FAU - Van Gasse, Athina L
AU  - Van Gasse AL
AD  - Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of 
      Excellence, Faculty of Medicine and Health Sciences, University of Antwerp and 
      Antwerp University Hospital, Antwerp, Belgium; Department of Paediatrics, Faculty 
      of Medicine and Health Sciences, University of Antwerp and Antwerp University 
      Hospital, Antwerp, Belgium.
FAU - Garvey, Lene H
AU  - Garvey LH
AD  - Allergy Clinic, Department of Dermatology and Allergy, Gentofte Hospital, 
      Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, 
      Denmark.
FAU - Bridts, Chris H
AU  - Bridts CH
AD  - Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of 
      Excellence, Faculty of Medicine and Health Sciences, University of Antwerp and 
      Antwerp University Hospital, Antwerp, Belgium.
FAU - De Puysseleyr, Leander P
AU  - De Puysseleyr LP
AD  - Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of 
      Excellence, Faculty of Medicine and Health Sciences, University of Antwerp and 
      Antwerp University Hospital, Antwerp, Belgium.
FAU - Mertens, Christel
AU  - Mertens C
AD  - Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of 
      Excellence, Faculty of Medicine and Health Sciences, University of Antwerp and 
      Antwerp University Hospital, Antwerp, Belgium.
FAU - Hagendorens, Margo M
AU  - Hagendorens MM
AD  - Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of 
      Excellence, Faculty of Medicine and Health Sciences, University of Antwerp and 
      Antwerp University Hospital, Antwerp, Belgium; Department of Paediatrics, Faculty 
      of Medicine and Health Sciences, University of Antwerp and Antwerp University 
      Hospital, Antwerp, Belgium.
FAU - Sabato, Vito
AU  - Sabato V
AD  - Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of 
      Excellence, Faculty of Medicine and Health Sciences, University of Antwerp and 
      Antwerp University Hospital, Antwerp, Belgium; Department of Immunology and 
      Allergology, AZ Jan Palfijn Gent, Ghent, Belgium.
FAU - Ebo, Didier G
AU  - Ebo DG
AD  - Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of 
      Excellence, Faculty of Medicine and Health Sciences, University of Antwerp and 
      Antwerp University Hospital, Antwerp, Belgium; Department of Immunology and 
      Allergology, AZ Jan Palfijn Gent, Ghent, Belgium. Electronic address: 
      immuno@uantwerpen.be.
LA  - eng
PT  - Journal Article
DEP - 20200722
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
RN  - R4KO0DY52L (Chlorhexidine)
SB  - IM
CIN - Br J Anaesth. 2020 Dec;125(6):856-859. PMID: 32988603
EIN - Br J Anaesth. 2021 Mar;126(3):748-749. PMID: 33341225
MH  - Adult
MH  - Aged
MH  - Chlorhexidine/*adverse effects/immunology
MH  - Drug Hypersensitivity/*blood/*diagnosis/immunology
MH  - Female
MH  - Humans
MH  - Hypersensitivity, Immediate/*blood/*diagnosis/immunology
MH  - Male
MH  - Mast Cells/*immunology/metabolism
MH  - Middle Aged
OTO - NOTNLM
OT  - CD63
OT  - allergy
OT  - anaphylaxis
OT  - basophil activation test
OT  - chlorhexidine
OT  - flow cytometry
OT  - immediate drug hypersensitivity reaction
OT  - mast cell activation test
EDAT- 2020/07/28 06:00
MHDA- 2020/12/02 06:00
CRDT- 2020/07/26 06:00
PHST- 2020/04/28 00:00 [received]
PHST- 2020/06/02 00:00 [revised]
PHST- 2020/06/20 00:00 [accepted]
PHST- 2020/07/28 06:00 [pubmed]
PHST- 2020/12/02 06:00 [medline]
PHST- 2020/07/26 06:00 [entrez]
AID - S0007-0912(20)30482-7 [pii]
AID - 10.1016/j.bja.2020.06.024 [doi]
PST - ppublish
SO  - Br J Anaesth. 2020 Dec;125(6):970-975. doi: 10.1016/j.bja.2020.06.024. Epub 2020 
      Jul 22.