TY - JOUR
T1 - Reliability of early and late testing for suspected perioperative hypersensitivity
AU - Van der Poorten, Marie-Line M
AU - Mark, Walschot
AU - Faber, Margaretha
AU - Elst, Jessy
AU - Van Gasse, Athina L
AU - De Puysseleyr, Leander
AU - Christel M, Mertens
AU - Hagendorens, Margo M
AU - Garvey, Lene H
AU - Sabato, Vito
AU - Ebo, Didier G
N1 - Copyright © 2021. Published by Elsevier Inc.
PY - 2022/4
Y1 - 2022/4
N2 - BACKGROUND: The optimal timing of diagnostic testing for perioperative hypersensitivity (POH) remains unknown. It has been recommended that investigation is best carried out at least 4 to 6 weeks after the event. On the other hand, guidelines discourage the use of in vitro tests later than 3 years after the index reaction.OBJECTIVE: This retrospective study aimed to assess the reliability of early and late skin tests (STs). It also attempted to verify whether discouraging late ex vivo and in vitro tests is substantiated.METHODS: For the first aim, patients were stratified over three epochs: an early timing group, with investigations performed within 6 weeks; a recommended timing group, with tests performed between 6 weeks and 6 months; and a late timing group, tested later than 6 months after the event. For the second study purpose, we studied the reliability of specific IgE quantification and basophil activation test rocuronium within 6 weeks and after 3 years in patients who experienced an ST-proven POH to rocuronium.RESULTS: A total of 677 patients were included. Based on a positive ST result, a causative agent was found in 74.2% of the early timing group, 62.6% of the recommended timing group, and 50% of the late timing group. A positive specific IgE for rocuronium or morphine was found in 80% of patients tested within 6 weeks, 63% of patients tested between 6 weeks and 3 years, and 50% of patients tested more than 3 years after the event. A positive basophil activation test was found in 83.3%, 51%, and 20%, respectively, of patients.CONCLUSIONS: Our data confirm that evaluation of drug allergy for suspected POH can be performed before 6 weeks after the event, and there is no maximal upper time limit disclosing ex vivo and in vitro testing.
AB - BACKGROUND: The optimal timing of diagnostic testing for perioperative hypersensitivity (POH) remains unknown. It has been recommended that investigation is best carried out at least 4 to 6 weeks after the event. On the other hand, guidelines discourage the use of in vitro tests later than 3 years after the index reaction.OBJECTIVE: This retrospective study aimed to assess the reliability of early and late skin tests (STs). It also attempted to verify whether discouraging late ex vivo and in vitro tests is substantiated.METHODS: For the first aim, patients were stratified over three epochs: an early timing group, with investigations performed within 6 weeks; a recommended timing group, with tests performed between 6 weeks and 6 months; and a late timing group, tested later than 6 months after the event. For the second study purpose, we studied the reliability of specific IgE quantification and basophil activation test rocuronium within 6 weeks and after 3 years in patients who experienced an ST-proven POH to rocuronium.RESULTS: A total of 677 patients were included. Based on a positive ST result, a causative agent was found in 74.2% of the early timing group, 62.6% of the recommended timing group, and 50% of the late timing group. A positive specific IgE for rocuronium or morphine was found in 80% of patients tested within 6 weeks, 63% of patients tested between 6 weeks and 3 years, and 50% of patients tested more than 3 years after the event. A positive basophil activation test was found in 83.3%, 51%, and 20%, respectively, of patients.CONCLUSIONS: Our data confirm that evaluation of drug allergy for suspected POH can be performed before 6 weeks after the event, and there is no maximal upper time limit disclosing ex vivo and in vitro testing.
KW - Anaphylaxis
KW - Anesthetic reactions
KW - Drug reactions
KW - In vitro diagnostics
KW - Perioperative hypersensitivity
KW - Skin testing
KW - sIgE quantification
UR - http://www.scopus.com/inward/record.url?scp=85120339260&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2021.10.066
DO - 10.1016/j.jaip.2021.10.066
M3 - Journal article
C2 - 34767998
SN - 2213-2198
VL - 10
SP - 1057-1062.e2
JO - The journal of allergy and clinical immunology. In practice
JF - The journal of allergy and clinical immunology. In practice
IS - 4
ER -