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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


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


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


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.


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.


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