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

Int Arch Allergy Immunol. 2005 Jan;136(1):58-72. doi: 10.1159/000082586. Epub 2004 Dec 8.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / immunology*
  • Aspirin / immunology*
  • Basophils / immunology*
  • Case-Control Studies
  • Drug Hypersensitivity / blood
  • Drug Hypersensitivity / diagnosis*
  • Drug Hypersensitivity / immunology
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Flow Cytometry / methods*
  • Humans
  • Immunologic Tests / methods*
  • In Vitro Techniques
  • Leukotrienes / blood*
  • Leukotrienes / immunology
  • Male
  • Middle Aged
  • Sensitivity and Specificity

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Leukotrienes
  • Aspirin