196 - Flow cytometric basophil activation test in patients with allergic or pseudoallergic reactions to betalactamic antibiotics and non steroidal anti inflammatory drugs
Autor(s): I. Brusca, S. Corrao, G. Sceusa, M. Barrale, G. Dragotto, T. Gristina, P. Li Vigni, V. Cantisano, S.M. La Chiusa
Issue: RIMeL - IJLaM, Vol. 3, N. 3, 2007 (MAF Servizi srl ed.)
Page(s): 196-202
Background. The diagnosis of hypersensivity drug reactions may be difficult and uncertain. Recently, new diagnostic tools has been introduced. They measure activation markers of human basophil by the use of cytofluorometry after in vitro incubation of these cells with drug. We analysed the results obtained by these tool in the diagnosis of hypersensivity drug reaction. Methods. We studied 138 patients who suffered from hypersensivity drug reactions [92 out of 138 had had an hypersensivity rection caused by betalactamic antibiotics (group A) and 46 by NSAIDs (group B)] and 30 volunteers (group C) who had never had hypersensivity reactions. All of the healthy subjects had undertaken NSAID and antibiotics in the last 12 month. Basophil activation has been studied by cytofluometry using CD63 as a marker. Tested allergenic antigens were: metimazol, ASA, ibuprofen, paracetamol (as NSAIDs) and penicillin G, penicillin V, amoxicillin, ampicillin, eMDM, PPL, cefuroxime, as betalactamic antibiotics (BLAT). Basophil activation was considered positive when we found out at least a doubled reaction respect to the control group. Results. In group A, 58 patients out of 92 resulted positive for at least one of the studied drugs (sensitivity = 63,0; 95%CI 53,6-72,5). In group B, 30 out of 46 presented significant basophil activation (sensitivity = 65,2; 95%CI 55,9-74,5). In group C, 4 patients were positive for BLAT and 7 for NSAID. Specificity was respectively 86,7 (95%CI 80,0-93,3) for BLAT and 76,7 (95%CI 68,4-84,9) for NSAID. The positive predictive value was 93,5 (95%CI 88,7-98,4) for BLAT and 81,1 for NSAID (95%CI 73,4-88,8). The negative predictive value was 43,3 (95%CI 33,6-53,1) for BLAT and 60,5 for NSAID (95%CI 50,9-70,1). Conclusions. Our data show a good diagnostic capacity of pseudo-allergic reaction by basophil activation, but specifity values suggest that we need more attention for a correct clinical evaluation.