sepharose and Drug-Hypersensitivity

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

In vitro tests for detecting drug-specific IgE would be useful in identifying patients at risk for immediate hypersensitivity reactions to therapeutic doses of a drug.. We attempted to verify that IgE-mediated reactions to erythromycin occur and to identify IgE antibodies specific for erythromycin in serum from a patient who had urticaria immediately after administration of the drug.. Skin prick testing was performed on the patient and five control subjects. Serum from the patient, pooled sera from nonatopic subjects allergic to common aeroallergens, and cord blood controls were analyzed for erythromycin-specific IgE by radioimmunoassay. Sepharose (Pharmacia, Uppsala, Sweden) was used as solid phase covalently linked to erythromycin.. We were able to detect erythromycin-specific IgE antibodies in serum from the patient who had an allergic reaction to this antibiotic, but specific IgE could not be detected in control sera.. Immunologic IgE-mediated reactions to erythromycin do occur, and in vitro diagnosis of such reactions can be made by using Sepharose as a solid phase covalently linked to this drug.

Topics: Adult; Drug Hypersensitivity; Erythromycin; Female; Humans; Immunoglobulin E; Radioimmunoassay; Sepharose; Skin Tests; Urticaria

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