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Background In Spain, drug adverse reactions are the third leading cause of consultation to Allergy Departments 1 . NSAID’s are the second group of drugs after betalactam antibiotics. The development of reliable and safe complementary tests is a highly demanded need at allergy diagnosis laboratories. Ex-vivo challenge tests with NSAID’s. Analysis of the role of basophil activation test Ramón López-Salgueiro Carolina Perales Borja Durán López Ana Giner Dolores Hernández Fernández de Rojas Department of Allergy IIS Hospital La Fe Valencia Spain Aims To study the usefulness of Basophil Activation Test (BAT) in the evaluation of NSAID induced immunological adverse reactions. Patients & Methods Forty-three patients (both gender, no age restrictions) evaluated during 2013 and 2014 for high clinical suspicion of NSAID induced immunological adverse reactions were included. Intradermal tests were performed according to EAACI/ENDA recommendations with suspect culprit drug and a NSAID panel. Results Female gender accounted for 58% of patients and 53% were over 15 years old. BAT was performed in all cases and intradermal skin tests were not performed to 17 patients. In the group of age <15 y-o the culprit drug was ibuprofen in 16 patients (76%), dypirone in 4 (19%) and acetaminophen in 1 (5%). In the group of age >15 y-o the culprit drug was dypirone in 10 patients (44%), ibuprofen in 7 (31%) and desketoprofen in 3 (13%). BAT was positive in 26 patients (60.46%) and negative in 17 (39.54%). BAT with ibuprofen was positive in 19 patients (82.60%) and negative in 5 (17.40%) while with dypirone was positive in 5 patients (38.43%) and negative in 9 (61.54%). Conclusion The culprit drug varies with age: ibuprofen is the main culprit NSAID in people under 15 years and dypirone in people over 15 years. BAT showed a higher rate of positive results than intradermal tests, especially with ibuprofen. BAT seems to be a more useful diagnostic option than intradermal tests to confirm the causality of immunological adverse reactions due to ibuprofen. References 1.- Alergologica 2005 (SEAIC). J Investig Allergol Clin Immunol. 2009;19, Suppl. 2: 7-13 Results (Cont.) Intradermal skin tests were positive in 10 (25%) patients and negative in 33 (75%). Ibuprofen skin test was positive in 2 (15.40%) patients and negative in 11 (84.60%). Dypirone skin test was positive in 4 patients (50%) and negative in 4 (50%). Contact Information [email protected] BAT was performed with 2 concentrations of the culprit drug, using a commercial kit (BASOTEST®) following the manufacturer’s protocol. Flow cytometric analysis was performed on a FACScan® flow cytometer and analyzed by CellQuest® software. The result was considered positive if basophil activation was => 5% or SI (stimulation index) =>2. Disclosures 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% POSITIVE NEGATIVE 82,60% 17,40% 15,40% 84,60% Ibuprofen TAB SPT 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% POSITIVE NEGATIVE 38,46% 61,54% 50% 50% Dypirone TAB SPT AE 21% Urticaria 25% AE/U 21% Skin rash 12% Anaphylaxis 9% Others 12% CLINICAL FEATURES In relation to this presentation, all authors declare that there are not conflicts of interest Patients & Methods (Cont.) 76% 19% 5% Culprit drug under 15 Ibuprofen Metamizol Acetaminofen 31% 44% 13% 4% 4% 4% Culprit drug over 15 Ibuprofen Metamizol Desketoprofen Acetaminophen Meloxicam Diclofenac

Patients & Methods (Cont.) Results (Cont.)

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Page 1: Patients & Methods (Cont.) Results (Cont.)

Background In Spain, drug adverse reactions are the third leading cause of consultation to Allergy Departments1.

NSAID’s are the second group of drugs after betalactam antibiotics.

The development of reliable and safe complementary tests is a highly demanded need at allergy diagnosis laboratories.

Ex-vivo challenge tests with NSAID’s. Analysis of the role of basophil activation test Ramón López-Salgueiro Carolina Perales Borja Durán López Ana Giner Dolores Hernández Fernández de Rojas Department of Allergy IIS Hospital La Fe Valencia Spain

Aims To study the usefulness of Basophil Activation Test (BAT) in the evaluation of NSAID induced immunological adverse reactions.

Patients & Methods Forty-three patients (both gender, no age restrictions) evaluated during 2013 and 2014 for high clinical suspicion of NSAID induced immunological adverse reactions were included. Intradermal tests were performed according to EAACI/ENDA recommendations with suspect culprit drug and a NSAID panel.

Results

Female gender accounted for 58% of patients and 53% were over 15 years old. BAT was performed in all cases and intradermal skin tests were not performed to 17 patients. In the group of age <15 y-o the culprit drug was ibuprofen in 16 patients (76%), dypirone in 4 (19%) and acetaminophen in 1 (5%). In the group of age >15 y-o the culprit drug was dypirone in 10 patients (44%), ibuprofen in 7 (31%) and desketoprofen in 3 (13%). BAT was positive in 26 patients (60.46%) and negative in 17 (39.54%). BAT with ibuprofen was positive in 19 patients (82.60%) and negative in 5 (17.40%) while with dypirone was positive in 5 patients (38.43%) and negative in 9 (61.54%).

Conclusion

The culprit drug varies with age: ibuprofen is the main culprit NSAID in people under 15 years and dypirone in people over 15 years. BAT showed a higher rate of positive results than intradermal tests, especially with ibuprofen. BAT seems to be a more useful diagnostic option than intradermal tests to confirm the causality of immunological adverse reactions due to ibuprofen.

References 1.- Alergologica 2005 (SEAIC). J Investig Allergol Clin Immunol. 2009;19, Suppl. 2: 7-13

Results (Cont.) Intradermal skin tests were positive in 10 (25%) patients and negative in 33 (75%). Ibuprofen skin test was positive in 2 (15.40%) patients and negative in 11 (84.60%). Dypirone skin test was positive in 4 patients (50%) and negative in 4 (50%).

Contact Information [email protected]

BAT was performed with 2 concentrations of the culprit drug, using a commercial kit (BASOTEST®) following the manufacturer’s protocol. Flow cytometric analysis was performed on a FACScan® flow cytometer and analyzed by CellQuest® software. The result was considered positive if basophil activation was => 5% or SI (stimulation index) =>2.

Disclosures

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

POSITIVE NEGATIVE

82,60%

17,40% 15,40%

84,60%

Ibuprofen

TAB SPT

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

POSITIVE NEGATIVE

38,46%

61,54%

50% 50%

Dypirone

TAB SPT

AE 21%

Urticaria 25%

AE/U 21%

Skin rash 12%

Anaphylaxis 9%

Others 12%

CLINICAL FEATURES

In relation to this presentation, all authors declare that there are not conflicts of interest

Patients & Methods (Cont.)

76%

19%

5%

Culprit drug under 15

Ibuprofen

Metamizol

Acetaminofen

31%

44%

13%

4% 4% 4%

Culprit drug over 15

Ibuprofen

Metamizol

Desketoprofen

Acetaminophen

Meloxicam

Diclofenac