Assessment of Cellular Antigen Stimulation Test in Diagnosis of Drug Allergy

Abstract

Adverse drug reactions (ADRs) account for 3% to 6% of all hospital admissions and occur in 10% to 15% of hospitalized patients.ADRs are broadly categorized into predictable (type A) and unpredictable (type B) reactions. Predictable reactions are usually dose dependent, are related to the known pharmacologic actions of the drug, and occur in otherwise healthy individuals. Unpredictable are generally dose independent, are unrelated to the pharmacologic actions of the drug, and occur only in susceptible individuals. Unpredictable reactions are subdivided into drug intolerance, drug idiosyncrasy, drug allergy (IgE mediated and accounts for less than 10% of all ADRs), and pseudo allergic reactions (non-IgE mediated). Specific diagnosis of immediate type allergies, such as rhinoconjunctivis, asthma, urticaria/angioedema and anaphylaxis, particularly when IgE-mediated, traditionally rests on prick and/or intradermal skin tests and on the determination of allergen specific IgEs. Some cellular tests, i.e. tests determining the reactivity of blood cells in vitro, particularly basophils, to allergens, have been available.The determination of histamine release has been widely used but its routine application in allergy diagnosis has been restricted to few groups. A cellular test, based on the determination of sulfidoleukotrienes (LTC4, LTD4, LTE4) produced by IL-3 primed basophils stimulated by allergens in vitro, has been proposed. This test became available commercially under the name of CAST.