Download - Patients & Methods (Cont.) Results (Cont.)
Background In Spain, drug adverse reactions are the third leading cause of consultation to Allergy Departments1.
NSAID’s are the second group of drugs after betalactam antibiotics.
The development of reliable and safe complementary tests is a highly demanded need at allergy diagnosis laboratories.
Ex-vivo challenge tests with NSAID’s. Analysis of the role of basophil activation test Ramón López-Salgueiro Carolina Perales Borja Durán López Ana Giner Dolores Hernández Fernández de Rojas Department of Allergy IIS Hospital La Fe Valencia Spain
Aims To study the usefulness of Basophil Activation Test (BAT) in the evaluation of NSAID induced immunological adverse reactions.
Patients & Methods Forty-three patients (both gender, no age restrictions) evaluated during 2013 and 2014 for high clinical suspicion of NSAID induced immunological adverse reactions were included. Intradermal tests were performed according to EAACI/ENDA recommendations with suspect culprit drug and a NSAID panel.
Results
Female gender accounted for 58% of patients and 53% were over 15 years old. BAT was performed in all cases and intradermal skin tests were not performed to 17 patients. In the group of age <15 y-o the culprit drug was ibuprofen in 16 patients (76%), dypirone in 4 (19%) and acetaminophen in 1 (5%). In the group of age >15 y-o the culprit drug was dypirone in 10 patients (44%), ibuprofen in 7 (31%) and desketoprofen in 3 (13%). BAT was positive in 26 patients (60.46%) and negative in 17 (39.54%). BAT with ibuprofen was positive in 19 patients (82.60%) and negative in 5 (17.40%) while with dypirone was positive in 5 patients (38.43%) and negative in 9 (61.54%).
Conclusion
The culprit drug varies with age: ibuprofen is the main culprit NSAID in people under 15 years and dypirone in people over 15 years. BAT showed a higher rate of positive results than intradermal tests, especially with ibuprofen. BAT seems to be a more useful diagnostic option than intradermal tests to confirm the causality of immunological adverse reactions due to ibuprofen.
References 1.- Alergologica 2005 (SEAIC). J Investig Allergol Clin Immunol. 2009;19, Suppl. 2: 7-13
Results (Cont.) Intradermal skin tests were positive in 10 (25%) patients and negative in 33 (75%). Ibuprofen skin test was positive in 2 (15.40%) patients and negative in 11 (84.60%). Dypirone skin test was positive in 4 patients (50%) and negative in 4 (50%).
Contact Information [email protected]
BAT was performed with 2 concentrations of the culprit drug, using a commercial kit (BASOTEST®) following the manufacturer’s protocol. Flow cytometric analysis was performed on a FACScan® flow cytometer and analyzed by CellQuest® software. The result was considered positive if basophil activation was => 5% or SI (stimulation index) =>2.
Disclosures
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
POSITIVE NEGATIVE
82,60%
17,40% 15,40%
84,60%
Ibuprofen
TAB SPT
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
POSITIVE NEGATIVE
38,46%
61,54%
50% 50%
Dypirone
TAB SPT
AE 21%
Urticaria 25%
AE/U 21%
Skin rash 12%
Anaphylaxis 9%
Others 12%
CLINICAL FEATURES
In relation to this presentation, all authors declare that there are not conflicts of interest
Patients & Methods (Cont.)
76%
19%
5%
Culprit drug under 15
Ibuprofen
Metamizol
Acetaminofen
31%
44%
13%
4% 4% 4%
Culprit drug over 15
Ibuprofen
Metamizol
Desketoprofen
Acetaminophen
Meloxicam
Diclofenac