Required cefazolin concentration to maximize diagnostic accuracy of the basophil activation test for cefazolin-induced anaphylaxis
Identifying the causative agent of perioperative anaphylaxis is key to preventing its recurrence. Besides skin testing, the basophil activation test (BAT) is increasingly being accepted as an additional and reliable method. Cefazolin seems to be a major cause of perioperative anaphylaxis. However, few studies have described use of the BAT for cefazolin-induced anaphylaxis. In this study, we aimed to determine the optimum cefazolin concentration required in the BAT for an accurate diagnosis.
Seven patients who presented with immediate hypersensitivity to cefazolin and 21 control subjects were studied. We conducted skin tests and performed BATs using both CD203c and CD63 as markers of activated basophils. We measured the ratio of activated basophils after stimulation with serial dilutions of cefazolin and investigated the cefazolin concentration that resulted in better sensitivity and specificity.
All patients demonstrated positive reactions to cefazolin, while all control subjects showed negative reactions on skin tests. The net percentage of both CD203c- and CD63-labeled activated basophils was greater when higher concentrations of cefazolin than previously reported were used. In control subjects, however, the number of activated basophils by cefazolin stimulation was negligible regardless of its concentration. In the case of CD203c, the sensitivity was 86% with a cefazolin concentration of 3 mg/ml, while in the case of CD63, the sensitivity was 100% with a cefazolin concentration of 10 mg/ml.
Using a higher concentration of cefazolin than previously reported for the BAT might increase the accuracy of diagnosis of cefazolin-induced anaphylaxis.
KeywordsAnaphylaxis Cefazolin Basophil activation test Skin test
We thank Dr. Kenzaburo Sugimoto of the Department of Anesthesiology, Jichi University Hospital, for his kind advice regarding the skin tests. This study was supported by JSPS KAKENHI Grant numbers JP 16M02678 and 15K10533, and the Kosaka Rinsyo Masui Fund.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
- 1.Mertes PM, Malinovsky JM, Jouffroy L, Working Group of the SFAR and SFA, Aberer W, Terreehorst I, Brockow K, Demoly P, ENDA, EAACI Interest Group on Drug Allergy. Reducing the risk of anaphylaxis during anesthesia: 2011 updated guidelines for clinical practice. J Investig Allergol Clin Immunol. 2011;21(6):442–53.PubMedGoogle Scholar
- 6.Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Guideline for Prevention of Surgical Site Infection. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27(2):97–132 (quiz 3–4; discussion 96).CrossRefGoogle Scholar
- 7.Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA, American Society of Health-System Pharmacists, Infectious Disease Society of America, Surgical Infection Society, Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect. 2013;14(1):73–156.CrossRefGoogle Scholar
- 9.Mayorga C, Sanz ML, Gamboa PM, Garcia BE, Caballero MT, Garcia JM, Labrador M, Lahoz C, Longo Areso N, López Hoyos M, Martínez Quesada J, Monteseirín FJ, Immunology Committee of the Spanish Society of Allergology and Clinical Immunology of the SEAIC. In vitro diagnosis of immediate allergic reactions to drugs: an update. J Investig Allergol Clin Immunol. 2010;20(2):103–9.PubMedGoogle Scholar
- 26.Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, Bircher A, Blanca M, Bonadonna B, Campi P, Castro E, Cernadas JR, Chiriac AM, Demoly P, Grosber M, Gooi J, Lombardo C, Mertes PM, Mosbech H, Nasser S, Pagani M, Ring J, Romano A, Scherer K, Schnyder B, Testi S, Torres M, Trautmann A, Terreehorst I, ENDA/EAACI Drug Allergy Interest Group. Skin test concentrations for systemically administered drugs—an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013;68(6):702–12.CrossRefGoogle Scholar
- 33.Marinho S, Kemp H, Cook TM, Farmer L, Farooque S, Lucas DN, Garcez T, Floss K, Torevell H, Thomas M, Warner A, Hitchman J, Ferguson K, Egner W, Nasser S, Karanam S, Kong KL, McGuire N, Bellamy M, Harper NJN. Cross-sectional study of perioperative drug and allergen exposure in UK practice in 2016: the 6th National Audit Project (NAP6) Allergen Survey. Br J Anaesth. 2018;121(1):146–58.CrossRefGoogle Scholar