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首页> 外文期刊>Allergy >Allergy to rocuronium: from clinical suspicion to correct diagnosis.
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Allergy to rocuronium: from clinical suspicion to correct diagnosis.

机译：对罗库溴铵过敏：从临床怀疑到正确诊断。

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BACKGROUND: Allergy to rocuronium can be life-threatening. Correct diagnosis is a prerequisite because of serious consequences of diagnostic error. OBJECTIVE: To assess skin testing, quantification of specific IgE (sIgE) and flow-assisted activation of basophils [basophil activation test (BAT)] in the diagnosis of rocuronium allergy. METHODS: This study comprises 104 curarized patients with a history of profound hypotension and severe bronchospasm immediately after induction of anaesthesia. All patients had skin tests, quantification of sIgE and BAT to rocuronium, together with investigations for all relevant compounds administered during anaesthesia that could have evoked the reaction. Diagnosis of rocuronium allergy was considered definite when the patient demonstrated a positive outcome for at least two of the three aforementioned tests. RESULTS: The positive predictive value for skin testing, BAT and sIgE was 98% (CI 95%: 92-99%), 97% (CI 95%: 88-100%) and 83% (CI 95%: 74-89%), respectively. The negative predictive value for skin testing, BAT and sIgE was 96% (CI 95%: 86-99%), 75% (CI 95%: 67-75%) and 72% (CI 95%: 58-83%), respectively. Cross-reactivity with vecuronium was documented in 69% of the patients. CONCLUSION: Skin testing merits the status of primary diagnostic investigation to document rocuronium allergy and cannot be substituted by quantification of sIgE or BAT. SIgE can offer a diagnostic advantage in cases where skin tests yield negative results. However, additional tests (e.g. BAT) are of capital importance in patients with negative skin tests and positive sIgE results to help in interpreting the clinical significance of a positive sIgE result. Optimal assessment of cross-reactivity between rocuronium and vecuronium implies both skin testing and BAT.
机译：背景：对罗库溴铵的过敏可能会危及生命。由于诊断错误的严重后果，正确诊断是前提。目的：评估皮肤测试，嗜碱性粒细胞特异性IgE（sIgE）定量和血流辅助激活[嗜碱性粒细胞激活测试（BAT）]，以诊断罗库溴铵过敏。方法：本研究包括104名经过麻醉的患者，这些患者在麻醉诱导后立即有严重的低血压和严重的支气管痉挛病史。所有患者均进行了皮肤测试，对罗库溴铵的sIgE和BAT定量，以及在麻醉期间可能引起反应的所有相关化合物的研究。当患者对上述三个测试中的至少两个显示出阳性结果时，罗库溴铵过敏的诊断被认为是明确的。结果：皮肤测试，BAT和sIgE的阳性预测值为98％（CI 95％：92-99％），97％（CI 95％：88-100％）和83％（CI 95％：74-89） ％）， 分别。皮肤测试，BAT和sIgE的阴性预测值为96％（CI 95％：86-99％），75％（CI 95％：67-75％）和72％（CI 95％：58-83％） ， 分别。据记录69％的患者与维库溴铵发生交叉反应。结论：皮肤测试应作为罗库溴铵过敏的主要诊断方法，不能用sIgE或BAT定量替代。在皮肤测试产生阴性结果的情况下，SIgE可以提供诊断优势。但是，对于皮肤试验阴性和sIgE结果阳性的患者，附加测试（例如BAT）至关重要，有助于解释sIgE阳性结果的临床意义。罗库溴铵和维库溴铵之间交叉反应的最佳评估意味着皮肤测试和最佳可行技术。

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