sepharose and Anaphylaxis

Topics: Anaphylaxis; Anesthetics; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Antibody Specificity; Contrast Media; Cross Reactions; Drug Hypersensitivity; Humans; Hypersensitivity, Immediate; Hypnotics and Sedatives; Immunoglobulin E; Immunoradiometric Assay; Intraoperative Complications; Latex Hypersensitivity; Narcotics; Neuromuscular Nondepolarizing Agents; Radioallergosorbent Test; Reproducibility of Results; Sensitivity and Specificity; Sepharose

Until now, immunoassays for detection of anti-muscle relaxant IgE in serum have been performed with the drug coupled to epoxy-activated Sepharose or to RAST papers dics. In the present work we have used a quaternary ammonium-Sepharose in which the quaternary ammonium reactive group (choline chloride) was directly coupled to Sepharose via an ether linkage. 50 microliters of the quaternary ammonium solid phase (QAS) was incubated with 50 microliters of serum for 3 h, washed, incubated 18 h with 125I-anti-IgE and washed again. The results were expressed as the percentage of 125I-anti-IgE absorbed onto the solid phase. The results were at 1.3 +/- 0.5% for 20 control sera, with an upper normal limit estimated to 2.3%. The within-run reproducibility ranged from 3.2% to 10.0%. The results were significantly correlated with those obtained with either alcuronium-epoxy-Sepharose, choline-epoxy-Sepharose, the RAST-alcuronium or with the RAST-succinyl choline (respectively, r = 0.66, r = 0.80, r = 0.81, r = 0.40 and r = 0.85). The values obtained with the sera of 83 patients ranged from 0.3 to 38.5%. The sensitivity was estimated at 87.9%, 66.7% and 40.7% with the QAS-RIA, the RAST-succinyl choline and the RAST-alcuronium, respectively. The inhibition of adsorption of specific IgE onto the gel ranged from 13.0 to 90.6% in presence of 130 nmol of soluble muscle relaxants. In 83.3% of 30 cases, the highest inhibition was obtained with the muscle relaxant which was clinically incriminated.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Alcuronium; Anaphylaxis; Evaluation Studies as Topic; Female; Humans; Immunoglobulin E; Male; Radioimmunoassay; Reproducibility of Results; Sensitivity and Specificity; Sepharose; Skin Tests; Succinylcholine

Subjects who experience life-threatening anaphylactic reactions to neuromuscular blocking drugs frequently have serum IgE antibodies that react with substituted ammonium groups on the drugs. Failure to detect drug-reactive antibodies may be due to the nature of the drug-solid support used for testing sera. With this in mind, solid phases of some selected compounds containing substituted ammonium groups, in particular triethylamine and morphine, were prepared and used to screen sera in an attempt to increase the frequency of detection of IgE antibodies complementary to tertiary and/or quaternary ammonium groups. For subjects who experienced an anaphylactic reaction to succinylcholine or gallamine, use of the supplementary assays increased the frequency of detection from 83 to 100%. For d-tubocurarine and alcuronium, detections increased from 92 to 100% and from 67 to 88%, respectively. Molecular models revealed a clear structural similarity between the conformations of the trialkylammonium groups on one face of the molecules of morphine and d-tubocurarine.

Topics: Anaphylaxis; Binding, Competitive; Drug Hypersensitivity; Ethylamines; Female; Haptens; Humans; Immunoassay; Immunoglobulin E; Male; Methylamines; Models, Molecular; Morphine; Neuromuscular Blocking Agents; Quaternary Ammonium Compounds; Sepharose