Integrating basophil activation tests into evaluation of perioperative anaphylaxis to neuromuscular blocking agents

Jamma Li, Oliver G. Best, Michael A. Rose, Sarah L. Green, Richard B. Fulton, Suran L. Fernando

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


BACKGROUND: Neuromuscular blocking agents (NMBAs) remain the leading cause of perioperative anaphylaxis in Australia. Standard evaluation comprises history, skin tests, and in vitro specific immunoglobulin E tests. Drug provocation tests to suspected NMBA culprits are associated with a significant risk. Basophil activation testing (BAT) is a potentially useful in vitro test that is not commercially available in Australia or as part of standard evaluation. METHODS: All patients attending the Anaesthetic Allergy Clinic in Sydney, Australia between May 2017 and July 2018 exposed to an NMBA before the onset of anaphylaxis during their anaesthetic qualified for the study. We recruited 120 patients sequentially who received standard evaluation plus BAT using CD63, CD203c, and CD300a as surface activation markers. RESULTS: BAT results were expressed as % upregulation above the negative control and stimulation index (mean fluorescence index of stimulated sample divided by the negative control). We calculated cut-offs of 4.45% and 1.44 for CD63, and 8.80% and 1.49 for CD203c, respectively. Sensitivity was 77% with specificity of 76%. A subgroup of 10 patients with NMBA anaphylaxis had no sensitisation on skin tests. BAT using CD63 and CD203c showed sensitisation in six of these 10, and adding CD300a identified sensitisation in nine patients. BAT was positive in seven of nine patients with anaphylaxis of unknown aetiology. CONCLUSIONS: BAT may be a useful supplement to the standard evaluation in diagnosing NMBA anaphylaxis in patients with suggestive histories, but no sensitisation on skin tests. Ongoing study of this specific group of patients is required to clarify its utility in clinical practice.
Original languageEnglish
Pages (from-to)e135-e143
Number of pages9
JournalBritish Journal of Anaesthesia
Issue number1
Publication statusPublished - Jul 2019
Externally publishedYes


  • Adolescent Adult Aged Anaphylaxis/*diagnosis/immunology Australia Basophils/*immunology Drug Hypersensitivity/*diagnosis/immunology Female Humans Intraoperative Complications/*chemically induced/diagnosis/immunology Male Middle Aged Neuromuscular Blocking Agents/*adverse effects/immunology Postoperative Complications/*chemically induced/diagnosis/immunology Sensitivity and Specificity Young Adult anaestehsia anaphylaxis basophil degranulation test drug hypersensitivity neuromuscular blocking agents skin tests
  • skin tests
  • basophil degranulation test
  • neuromuscular blocking agents
  • anaphylaxis
  • anaestehsia
  • drug hypersensitivity


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