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Allergy, Asthma & Clinical Immunology
Published in: Allergy, Asthma & Clinical Immunology 1/2013

Open Access 01-12-2013 | Research

Threshold for basophil activation test positivity in neuromuscular blocking agents hypersensitivity reactions

Authors: Natalia Hagau, Nadia Gherman-Ionica, Manuela Sfichi, Cristina Petrisor

Published in: Allergy, Asthma & Clinical Immunology | Issue 1/2013

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Abstract

Background

Several different criteria for the positivity of the flow-assisted Basophil Activation Test (BAT) for the diagnosis of Neuromuscular Blocking Agents (NMBA) hypersensitivity reactions have been used in past studies. Our aims were to determine the threshold for BAT positivity expressed as the stimulation index (SI, calculated as the percentage of activated basophils after stimulation with NMBA divided by the number of basophils with no NMBA stimulation) and as the percentage of activated basophils, and to determine the sensitivity and specificity of BAT for NMBAs.

Methods

22 consenting adult patients with previous intraanaesthetic NMBAs-related hypersensitivity reactions were tested for the culprit drug. 34 controls who tolerated NMBAs were similarly tested. BAT was performed using Flow2Cast technique and the up-regulation of the CD63 marker on the basophils was measured using Cell Quest programme (FACSCalibur Becton Dickinson, USA). Receiver operating characteristics curve (ROC) analysis was performed.

Results

ROC curve analysis for BAT results versus history yields a stimulation index of 1.76 as the optimal threshold, with an AUC of 0.81 (CI 95% 0.69-0.93, p < 0.01) and a percentage of activated basophils > 5.01%, with an AUC of 0.84 (CI 95% 0.72-0.95, p < 0.01). Considering both thresholds (the SI ≥ 1.76 together with the percentage of activated basophils > 5%) as diagnostic criteria, 15 patients had positive BAT, the overall BAT sensitivity being 68.18% (CI 95% 45.11-82.26%). None of the controls fulfilled both criteria and the specificity of the test was 100% (CI 95% 87.35-100%).

Conclusions

With a stimulation index ≥ 1.76 and a percentage of activated basophils > 5.01% as threshold, the performance of BAT for NMBAs yields 68.18% sensitivity and 100% specificity.
Appendix
Available only for authorised users
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Metadata
Title
Threshold for basophil activation test positivity in neuromuscular blocking agents hypersensitivity reactions
Authors
Natalia Hagau
Nadia Gherman-Ionica
Manuela Sfichi
Cristina Petrisor
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Allergy, Asthma & Clinical Immunology / Issue 1/2013
Electronic ISSN: 1710-1492
DOI
https://doi.org/10.1186/1710-1492-9-42

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