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Practitioner's Corner
J Investig Allergol Clin Immunol 2019; Vol. 29(5): 378-398 © 2019 Esmon Publicidad
Manuscript received February 18, 2019; accepted for publication
April 23, 2019.
Francisca Vílchez Sánchez
Servicio de Alergología
Hospital Universitario La Paz
Paseo de la Castellana, 261
28046 Madrid, Spain
E-mail:
at 0.2 mg/mL (0.8 in the control), and negative with etomidate,
fentanyl, and rocuronium. The patient was diagnosed with
anaphylaxis to amiodarone.
An 84-year-old woman with hypertension and
hyperlipidemia and no history of allergy was examined in the
emergency room for palpitations. She had paroxysmal atrial
fibrillation and was treated with intravenous amiodarone.
Fifteen minutes after the amiodarone infusion she developed
severe genital itching and redness with rash. The symptoms
resolved with antihistamines and corticosteroids.
The patient was referred to our allergy department. An
appropriate clinical history was taken, and a complete physical
examination was performed. The total serum IgE level was
113 kU/L. BAT with amiodarone based on the protocol
described above was performed for safety reasons. The result
was positive with intravenous amiodarone (60% activation)
(Figure), with an SI of 30 and an amiodarone concentration
of 0.2 mg/mL (SI of 1.3 in the control); therefore, the patient
was diagnosed with immediate allergic rash induced by
amiodarone.
We present the first 2 cases of immediate hypersensitivity
to amiodarone with a positive BAT result.
Hypersensitivity reactions to drugs account for 15% of
all adverse drug reactions [10] and represent a major health
problem with significant morbidity and mortality. In the
diagnosis of drug hypersensitivity, in vitro measurement of
specific IgE is available for a limited number of drugs (it is
often impossible to bind the molecules or their metabolites
into a solid phase), which generally display low sensitivity and
for which BAT is a very suitable complementary approach.
Although rare, systemic reactions with skin tests have been
described.
BAT seems to be a promising complementary in vitro
technique in the allergological work-up of anaphylactic
reactions to drugs.
The sensitivity of BAT in the diagnosis of drug allergy is
about 50%, and the specificity can reach 93% [7], although
these data depend on the drug in question [10].
BAT is recommended for diagnosing hypersensitivity
reactions to penicillins and neuromuscular blocking agents
and can complement other in vitro tests. In addition, BAT
can be recommended for diagnosing IgE-mediated allergy to
pyrazolones, fluoroquinolones, and radiocontrast media. In
life-threatening reactions or in high-risk patients, BAT, when
available, should be performed before in vivo approaches,
including skin testing, according to the position paper of
the ENDA/EAACI Drug Allergy Interest Group on in vitro
testing for drug hypersensitivity reactions [10]. Despite the
fact that we report only 2 cases, our results indicate that BAT
is a useful diagnostic technique in hypersensitivity reactions
to amiodarone.
Funding
The authors declare that no funding was received for the
present study.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
Previous Presentation
This manuscript was presented in part as a poster in the
XXXI Congreso de la Sociedad Española de Alergología e
Inmunología Clínica SEAIC 2018.
References
1. Okuyan H, Altin C, Arihan O. Anaphylaxis during intravenous
administration of amiodarone. Ann Card Anaesth.
2013;16:229-30.
2. Fransi S, Breidis J. Anaphylaxis to Intravenous Amiodarone.
Anaesth Intensive Care. 2004;32:578-9.
3. Burches E, García-Verdgay F, Ferrer M, Peláez A. Amiodarone-
induced angioedema. Allergy. 2000;55:1199-200.
4. Lahiri K, Malakar S, Sarma N. Amiodarone-induced
angioedema: Report of two cases. Indian J Dermatol Venereol
Leprol. 2005;71:46-7.
5. Akoun GM, Gauthier-Rahman S, Milleron BJ, Mayaud CM.
Amiodarona-induced hypersensitivity pneumonitis. Evidence
of an immunological cell-mediated mechanism. Chest.
1984;85:133-5.
6. Phillips-Angles E, González-Muñoz M, Domínguez-Ortega J,
Cabañas R, Quirce S. Usefulness of basophil activation test
in diagnosis of hypersensitivity to etoricoxib. J Allergy Clin
Immunol Pract. 2016;4(2):350-1.
7. Steiner M, Harrer A, Himly M. Basophil Reactivity as Biomarker
in Immediate Drug Hypersensitivity Reactions-Potential and
Limitations. Front Pharmacol. 2016;7:171.
8. Entrala A, Dominguez-Ortega J, González-Muñoz M, Fiandor
A, Quirce S. Usefulness of the Basophil Activation Test to
Confirm Beer Allergy. J Investig Allergol Clin Immunol.
2018;28(4):279-80.
9. Hoffman HJ, Santos AF, Mayorga C, Nopp A, Eberlein B,
et al. The clinical utility of basophil activation testing in
diagnosis and monitoring of allergic disease. Allergy. 2015.
Nov:70(11):1393-405.
10. Mayorga C, Celik G, Rouzaire P, Whitaker P, Bonadonna
P, Rodrigues-Cernadas J, et al. In vitro test for drug
hypersensitivity reactions: an ENDA/EAACI Drug Allergy
Interest Group position paper. Allergy. 2016;Aug71(8):1103-
34.
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