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Vol. 136, No. 1, 2005
Issue release date: January 2005
Section title: Original Paper
Int Arch Allergy Immunol 2005;136:58–72
(DOI:10.1159/000082586)

A New Combined Test with Flowcytometric Basophil Activation and Determination of Sulfidoleukotrienes Is Useful for in vitro Diagnosis of Hypersensitivity to Aspirin and other Nonsteroidal Anti-Inflammatory Drugs

Sanz M.L. · Gamboa P. · de Weck A.L.
aDepartment of Allergology and Clinical Immunology, University of Navarra, Pamplona, and bAllergy Unit, Hospital Basurto, Bilbao, Spain

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 12/18/2003
Accepted: 7/20/2004
Published online: 2/2/2005

Number of Print Pages: 15
Number of Figures: 2
Number of Tables: 4

ISSN: 1018-2438 (Print)
eISSN: 1423-0097 (Online)

For additional information: http://www.karger.com/IAA

Abstract

Background: We assessed whether nonsteroidal anti-inflammatory drugs (NSAIDs) may provoke blood basophil activation in vitro in aspirin- and NSAID-hypersensitive patients, as detected by a flowcytometric technique using the CD63 marker – flowcytometric basophil activation test (FAST) assay – in addition to the sulfidoleukotriene (sLT) release – the cellular allergen stimulation test (CAST). Methods: Sixty aspirin- and/or NSAID-hypersensitive patients were studied. Thirty control patients without history and negative provocation challenge were also included. The percentage of activated basophils after in vitro stimulation with NSAIDs at 3 different concentrations was evaluated by an anti-CD63 phycoerythrin conjugate (FAST assay) and the amount of sLTs released in the cell supernatant by ELISA (CAST assay). Results: For aspirin, the FAST indicated a sensitivity of 41.7%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 99.4%; for paracetamol 11.7 and 100%, for metamizol 15 and 100%, for diclofenac 43.3 and 93.3%, and for naproxen 54.8 and 74.1%. Many patients showed positive tests to more than 1 NSAID. When considering the first 4 NSAIDs, the global sensitivity increased to 66.7%, while the specificity remained at 93.3%. The addition of the CAST results still increased the sensitivity up to 73.3%, but with a decrease of the specificity to 71.4%. Conclusions: The FAST shows a high percentage of positive reactions, which may reach 60–70% when 4 NSAIDs are tested and even 88% when the test is performed within 1 month of the last clinical drug exposure and reaction. The test has a high specificity above 90%. The addition of sLT determinations yields additional information in a few isolated cases. It is suggested that this test, when properly used, may help avoid some cumbersome and dangerous provocation challenges.


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 12/18/2003
Accepted: 7/20/2004
Published online: 2/2/2005

Number of Print Pages: 15
Number of Figures: 2
Number of Tables: 4

ISSN: 1018-2438 (Print)
eISSN: 1423-0097 (Online)

For additional information: http://www.karger.com/IAA


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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