Differentiating the cellular and humoral components of neuromuscular blocking agent- induced anaphylactic reactions in patients undergoing anaesthesia

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Presentation transcript:

Differentiating the cellular and humoral components of neuromuscular blocking agent- induced anaphylactic reactions in patients undergoing anaesthesia R.C. Aalberse, I. Kleine Budde, M. Mulder, S.O. Stapel, W. Paulij, F. Leynadier, M.W. Hollmann British Journal of Anaesthesia Volume 106, Issue 5, Pages 665-674 (May 2011) DOI: 10.1093/bja/aer028 Copyright © 2011 The Author(s) Terms and Conditions

Fig 1 Concentration of IgE antibodies to rocHSA in a reference group of atopic patients without a history of perioperative allergic reactions and in patients who experienced an anaphylactic event while receiving an NMBA during surgery. Individual concentrations (circles) and geometric mean (horizontal lines) with standard error of the geometric mean (sem; vertical bars) for the two groups are presented. A blank-corrected IgE value of ≥1 IU ml−1 was considered positive. British Journal of Anaesthesia 2011 106, 665-674DOI: (10.1093/bja/aer028) Copyright © 2011 The Author(s) Terms and Conditions

Fig 2 Correlation between the concentration of IgE to rocHSA and IgE to succinylcholine in the serum of patients who experienced an anaphylactic event while receiving an NMBA during surgery. The two closed circles indicate serum samples S1 and S30, obtained from two separate patients, which were able to sensitize basophils to release histamine in response to rocHSA. British Journal of Anaesthesia 2011 106, 665-674DOI: (10.1093/bja/aer028) Copyright © 2011 The Author(s) Terms and Conditions

Fig 3 Sensitization of donor basophils to release histamine. (a) and (b) are two representatives of a total of five experiments. S1 and S30 are serum samples from two separate patients. RocHSA is rocuronium bromide conjugated to human serum albumin. The positive control was anti-IgE and the negative control was HEPES buffer with IL-3. British Journal of Anaesthesia 2011 106, 665-674DOI: (10.1093/bja/aer028) Copyright © 2011 The Author(s) Terms and Conditions

Fig 4 Inhibition of histamine release from basophils sensitized by serum sample S30 (one of only two serum samples able to sensitize basophils to release histamine in response to rocHSA) upon challenge of the basophils with unconjugated rocHSA at concentrations of 0.2, 2, 20, or 200 μmol litre−1. British Journal of Anaesthesia 2011 106, 665-674DOI: (10.1093/bja/aer028) Copyright © 2011 The Author(s) Terms and Conditions

Fig 5 Correlation between level of skin-test reactivity to rocuronium (a) or succinylcholine (b) and concentration of IgE to rocHSA (upper panels) and IgE to succinylcholine (lower panels). The horizontal lines and vertical bars represent the medians and inter-quartile range. The closed circles indicate the serum samples, S1 and S30, obtained from two separate patients, which were able to sensitize basophils to release histamine in response to rocHSA. For S1, no skin test results for rocuronium were available, thus only S30 is shown in (a). roc, rocuronium; sux, succinylcholine. British Journal of Anaesthesia 2011 106, 665-674DOI: (10.1093/bja/aer028) Copyright © 2011 The Author(s) Terms and Conditions