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AL De Weck,1 ML Sanz,1
PM Gamboa,2 W Aberer,3 M
Blanca,4 S Correia,7 S Erdman,6
JM Jermann,8 G Kanny,9 M Kowalski,10
L Mayorga,4 W Medrala,5 A Merk,6
GJ Sturm,3 J Sainte-Laudy,11
MS Schneider,8 A Sczczeklik,12 JM
Weber,8 A Wedi,13 and members of
the ENDA group |
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1 Department of Allergology and
Clinical Immunology, Clínica Universidad de Navarra,
Collaborative center of GA2LEN, Pamplona, Spain
2 Hospital Basurto, Division of Allergy, Bilbao, Spain
3 Department of Dermatology, Medical University of Graz,
Austria
4 Hopital Haya, Malaga, Spain
5 University Hospital, Allergology, Wroclaw, Poland
6 Dermatology Clinic, University Hospital Aachen,
Germany
7 Allergy Division, Hospital, Setubal, Portugal
8 Bühlmann Laboratories, Allschwil, Switzerland
9 Centre Hospitalier Universitaire, Médecine, Nancy,
France
10 University Hospital, Lodz, Poland
11 Centre Hospitalier Universitaire, Limoges, France
12University Hospital, Cracow, Poland
13 Dermatology Clinic, University Hospital, Hanover,
Germany |
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Abstract |
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Background:
We present the
results obtained
from the largest
series of in vitro
diagnostic tests
ever reported in
patients with
clinically validated
hypersensitivity to
acetylsalicylic acid
(ASA)/nonsteroidal
anti-inflammatory
drugs (NSAID)
compared with
various categories
of controls
tolerating ASA/NSAIDs.
This multicenter
study, which was
performed within the
framework of the
European Network for
Drug Allergy (ENDA)
group, showed that
the basophil
activation test
(BAT), particularly
when used with the 3
NSAIDs aspirin (ASA),
diclofenac (DIC),
and naproxen (NAP),
allows us to confirm
the diagnosis of
NSAID
hypersensitivity
syndrome. The
results of the
cellular allergen
stimulation test
(CAST) frequently
correlate with those
of the BAT, although
not always. An
unexpected fi nding
was that basophil
activation by NSAIDs
is not an
all-or-nothing
phenomenon
restricted to
clinically
hypersensitive
patients, but that
it also occurs in a
dose-related manner
in some NSAID-tolerant
control individuals.
Therefore, NSAID
hypersensitivity
appears as a shift
in the normal
pharmacological
response to NSAIDs.
These fi ndings
allow us to
formulate a new
rational hypothesis
about the mechanism
of NSAID
hypersensitivity
syndrome, a
mechanism that most
authors continue to
describe as
unknown.
Methods: We
enrolled 152
patients with a
history of
hypersensitivity to
NSAIDs and 136
control participants
in 11 different
centers between
spring 2003 and
spring 2006.
Flowcytometric BAT
was performed.
Results: The
most noteworthy
results of our study
were that 57% of 140
patients presented
very clear-cut
positive BAT results
to multiple NSAIDs,
and 16% were
entirely negative.
In about 27% of
cases, positive
results were
obtained with 1 or 2
concentrations of a
single NSAID. There
is clearly a
correlation between
the results of BAT
and CAST.
Conclusions:
BAT seems
particularly
indicated in
patients with a
clinical history of
NSAID intolerance,
and in whom a
provocation test is
not advisable for
ethical, clinical,
or other reasons.
Clear-cut positive
results can be
considered as
confirming a history
of NSAID
hypersensitivity,
although negative
results may not
exclude it.
Key words:
NSAID
hypersensitivity
syndrome. Clinical
findings. In vitro
diagnosis. Basophil
activation test.
Flowcytometry.
Sulphidoleukotrienes.
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