Role of Histamine Release Test for the Evaluation of Patients with Immediate Hypersensitivity Reactions to Clavulanic Acid

F. Pineda, A. Ariza, C. Mayorga, F. Arribas, R. González-Mendiola, N. Blanca-López, G. Davila, N. Cabanes, G. Canto, J. J. Laguna, C. Senent, Per Stahl Skov, R. Palacios, M. Blanca, M. J. Torres

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Resumé

Immediate hypersensitivity reactions to clavulanic acid (CLV) seem to be on the increase. Diagnosis is mainly based on skin testing and the drug provocation test (DPT), procedures that are not risk free. The aim of this study was to evaluate whether the histamine release test (HRT) could help evaluate patients with selective hypersensitivity to CLV. Methods: Eighteen patients with immediate selective hypersensitivity reactions to CLV (positive skin tests to CLV but negative to the major and minor determinants of benzylpenicillin and amoxicillin; negative DPT to benzylpenicillin and amoxicillin) and 21 controls with tolerance to CLV were included. Direct and passive HRT, using patient whole blood or 'IgE-stripped' donor blood sensitized by patient serum, respectively, were performed by stimulating the blood with CLV, and basophil histamine release was detected by fluorometric determination. Results: The clinical symptoms were anaphylaxis (n = 6), urticaria (n = 9) and urticaria-angioedema (n = 3). The median time interval between the reaction and the study was 225 days (interquartile range, IQR: 120-387.5) and between drug intake and the development of symptoms 30 min (IQR: 6.25-30). We obtained similar data for both the direct and passive HRT, with a sensitivity and specificity of 55 and 85%, respectively, a positive predictive value of 76% and a negative predictive value of 69%. Conclusions: The sensitivity of both the direct and passive HRT for diagnosing patients with immediate allergy to CLV is less than 60%. However, the passive HRT has the advantage that it is based on the testing of serum samples that can be handled more easily than fresh blood samples. © 2016 S. Karger AG, Basel.
OriginalsprogEngelsk
TidsskriftInternational Archives of Allergy and Immunology
Vol/bind168
Udgave nummer4
Sider (fra-til)233-240
ISSN1018-2438
DOI
StatusUdgivet - 2015

Citer dette

Pineda, F., Ariza, A., Mayorga, C., Arribas, F., González-Mendiola, R., Blanca-López, N., ... Torres, M. J. (2015). Role of Histamine Release Test for the Evaluation of Patients with Immediate Hypersensitivity Reactions to Clavulanic Acid. International Archives of Allergy and Immunology, 168(4), 233-240. https://doi.org/10.1159/000443274
Pineda, F. ; Ariza, A. ; Mayorga, C. ; Arribas, F. ; González-Mendiola, R. ; Blanca-López, N. ; Davila, G. ; Cabanes, N. ; Canto, G. ; Laguna, J. J. ; Senent, C. ; Skov, Per Stahl ; Palacios, R. ; Blanca, M. ; Torres, M. J. / Role of Histamine Release Test for the Evaluation of Patients with Immediate Hypersensitivity Reactions to Clavulanic Acid. I: International Archives of Allergy and Immunology. 2015 ; Bind 168, Nr. 4. s. 233-240.
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abstract = "Immediate hypersensitivity reactions to clavulanic acid (CLV) seem to be on the increase. Diagnosis is mainly based on skin testing and the drug provocation test (DPT), procedures that are not risk free. The aim of this study was to evaluate whether the histamine release test (HRT) could help evaluate patients with selective hypersensitivity to CLV. Methods: Eighteen patients with immediate selective hypersensitivity reactions to CLV (positive skin tests to CLV but negative to the major and minor determinants of benzylpenicillin and amoxicillin; negative DPT to benzylpenicillin and amoxicillin) and 21 controls with tolerance to CLV were included. Direct and passive HRT, using patient whole blood or 'IgE-stripped' donor blood sensitized by patient serum, respectively, were performed by stimulating the blood with CLV, and basophil histamine release was detected by fluorometric determination. Results: The clinical symptoms were anaphylaxis (n = 6), urticaria (n = 9) and urticaria-angioedema (n = 3). The median time interval between the reaction and the study was 225 days (interquartile range, IQR: 120-387.5) and between drug intake and the development of symptoms 30 min (IQR: 6.25-30). We obtained similar data for both the direct and passive HRT, with a sensitivity and specificity of 55 and 85{\%}, respectively, a positive predictive value of 76{\%} and a negative predictive value of 69{\%}. Conclusions: The sensitivity of both the direct and passive HRT for diagnosing patients with immediate allergy to CLV is less than 60{\%}. However, the passive HRT has the advantage that it is based on the testing of serum samples that can be handled more easily than fresh blood samples. {\circledC} 2016 S. Karger AG, Basel.",
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Pineda, F, Ariza, A, Mayorga, C, Arribas, F, González-Mendiola, R, Blanca-López, N, Davila, G, Cabanes, N, Canto, G, Laguna, JJ, Senent, C, Skov, PS, Palacios, R, Blanca, M & Torres, MJ 2015, 'Role of Histamine Release Test for the Evaluation of Patients with Immediate Hypersensitivity Reactions to Clavulanic Acid', International Archives of Allergy and Immunology, bind 168, nr. 4, s. 233-240. https://doi.org/10.1159/000443274

Role of Histamine Release Test for the Evaluation of Patients with Immediate Hypersensitivity Reactions to Clavulanic Acid. / Pineda, F.; Ariza, A.; Mayorga, C.; Arribas, F.; González-Mendiola, R.; Blanca-López, N.; Davila, G.; Cabanes, N.; Canto, G.; Laguna, J. J.; Senent, C.; Skov, Per Stahl; Palacios, R.; Blanca, M.; Torres, M. J.

I: International Archives of Allergy and Immunology, Bind 168, Nr. 4, 2015, s. 233-240.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Role of Histamine Release Test for the Evaluation of Patients with Immediate Hypersensitivity Reactions to Clavulanic Acid

AU - Pineda, F.

AU - Ariza, A.

AU - Mayorga, C.

AU - Arribas, F.

AU - González-Mendiola, R.

AU - Blanca-López, N.

AU - Davila, G.

AU - Cabanes, N.

AU - Canto, G.

AU - Laguna, J. J.

AU - Senent, C.

AU - Skov, Per Stahl

AU - Palacios, R.

AU - Blanca, M.

AU - Torres, M. J.

N1 - Cited By :4 Export Date: 22 March 2017 CODEN: IAAIE

PY - 2015

Y1 - 2015

N2 - Immediate hypersensitivity reactions to clavulanic acid (CLV) seem to be on the increase. Diagnosis is mainly based on skin testing and the drug provocation test (DPT), procedures that are not risk free. The aim of this study was to evaluate whether the histamine release test (HRT) could help evaluate patients with selective hypersensitivity to CLV. Methods: Eighteen patients with immediate selective hypersensitivity reactions to CLV (positive skin tests to CLV but negative to the major and minor determinants of benzylpenicillin and amoxicillin; negative DPT to benzylpenicillin and amoxicillin) and 21 controls with tolerance to CLV were included. Direct and passive HRT, using patient whole blood or 'IgE-stripped' donor blood sensitized by patient serum, respectively, were performed by stimulating the blood with CLV, and basophil histamine release was detected by fluorometric determination. Results: The clinical symptoms were anaphylaxis (n = 6), urticaria (n = 9) and urticaria-angioedema (n = 3). The median time interval between the reaction and the study was 225 days (interquartile range, IQR: 120-387.5) and between drug intake and the development of symptoms 30 min (IQR: 6.25-30). We obtained similar data for both the direct and passive HRT, with a sensitivity and specificity of 55 and 85%, respectively, a positive predictive value of 76% and a negative predictive value of 69%. Conclusions: The sensitivity of both the direct and passive HRT for diagnosing patients with immediate allergy to CLV is less than 60%. However, the passive HRT has the advantage that it is based on the testing of serum samples that can be handled more easily than fresh blood samples. © 2016 S. Karger AG, Basel.

AB - Immediate hypersensitivity reactions to clavulanic acid (CLV) seem to be on the increase. Diagnosis is mainly based on skin testing and the drug provocation test (DPT), procedures that are not risk free. The aim of this study was to evaluate whether the histamine release test (HRT) could help evaluate patients with selective hypersensitivity to CLV. Methods: Eighteen patients with immediate selective hypersensitivity reactions to CLV (positive skin tests to CLV but negative to the major and minor determinants of benzylpenicillin and amoxicillin; negative DPT to benzylpenicillin and amoxicillin) and 21 controls with tolerance to CLV were included. Direct and passive HRT, using patient whole blood or 'IgE-stripped' donor blood sensitized by patient serum, respectively, were performed by stimulating the blood with CLV, and basophil histamine release was detected by fluorometric determination. Results: The clinical symptoms were anaphylaxis (n = 6), urticaria (n = 9) and urticaria-angioedema (n = 3). The median time interval between the reaction and the study was 225 days (interquartile range, IQR: 120-387.5) and between drug intake and the development of symptoms 30 min (IQR: 6.25-30). We obtained similar data for both the direct and passive HRT, with a sensitivity and specificity of 55 and 85%, respectively, a positive predictive value of 76% and a negative predictive value of 69%. Conclusions: The sensitivity of both the direct and passive HRT for diagnosing patients with immediate allergy to CLV is less than 60%. However, the passive HRT has the advantage that it is based on the testing of serum samples that can be handled more easily than fresh blood samples. © 2016 S. Karger AG, Basel.

U2 - 10.1159/000443274

DO - 10.1159/000443274

M3 - Journal article

VL - 168

SP - 233

EP - 240

JO - International Archives of Allergy and Immunology

JF - International Archives of Allergy and Immunology

SN - 1018-2438

IS - 4

ER -