Diagnosis of neuromuscular blocking agent hypersensitivity reactions using cytofluorimetric analysis of basophils

Background:  Immunoglobulin E (IgE)-mediated hypersensitivity reactions to neuromuscular blocking agents (NMBA) are common and life threatening. Basophil activation based upon the expression of CD63 in the presence of specific allergens was found to be of importance for the diagnosis of IgE-mediated hypersensibility. Methods:  The Basotest® was evaluated for the diagnosis of NMBA in 47 patients with proven NMBA anaphylaxis, 40 atopic subjects nonallergic to NMBA and five healthy volunteers. Diagnosis of NMBA was made according to international standards on clinical history, skin tests and provocation tests when needed. Results:  In the NMBA allergic patients, sensitivity of Basotest® was 36.1%, but it increased to 85.7% for reactions which occurred within the last 3 years. The specificity was 93.3%. Conclusion:  Basotest® may be useful for the diagnosis of NMBA allergy in patients with a suspicion of recent IgE-mediated hypersensitivity reaction to NMBA.