Nonsteroidal anti-inflammatory drug hypersensitivity syndrome. A multicenter study I. clinical findings and in vitro diagnosis

ackground: We present the results obtained from the largest series of in vitro diagnostic tests ever reported in patients with clinically validated hypersensitivity to acetylsalicylic acid (ASA)/nonsteroidal anti-infl ammatory drugs (NSAID) compared with various categories of controls tolerating ASA/NSAIDs. This multicenter study, which was performed within the framework of the European Network for Drug Allergy (ENDA) group, showed that the basophil activation test (BAT), particularly when used with the 3 NSAIDs aspirin (ASA), diclofenac (DIC), and naproxen (NAP), allows us to confi rm the diagnosis of NSAID hypersensitivity syndrome. The results of the cellular allergen stimulation test (CAST) frequently correlate with those of the BAT, although not always. An unexpected fi nding was that basophil activation by NSAIDs is not an all-or-nothing phenomenon restricted to clinically hypersensitive patients, but that it also occurs in a dose-related manner in some NSAID-tolerant control individuals. Therefore, NSAID hypersensitivity appears as a shift in the normal pharmacological response to NSAIDs. These fi ndings allow us to formulate a new rational hypothesis about the mechanism of NSAID hypersensitivity syndrome, a mechanism that most authors continue to describe as “unknown.” Methods: We enrolled 152 patients with a history of hypersensitivity to NSAIDs and 136 control participants in 11 different centers between spring 2003 and spring 2006. Flowcytometric BAT was performed. Results: The most noteworthy results of our study were that 57% of 140 patients presented very clear-cut positive BAT results to multiple NSAIDs, and 16% were entirely negative. In about 27% of cases, positive results were obtained with 1 or 2 concentrations of a single NSAID. There is clearly a correlation between the results of BAT and CAST. Conclusions: BAT seems particularly indicated in patients with a clinical history of NSAID intolerance, and in whom a provocation test is not advisable for ethical, clinical, or other reasons

The possible effect of a sanitization program on intraspecies differentiation of Listeria monocytogenes strains isolated from a fish processing plant

Forty-seven Listeria monocytogenes strains isolated during a year in a selected Polish fish-processing plant as well as 7 L. monocytogenes strains of different origins (including a reference strain) were analyzed in our studies. Strains were isolated from raw fish fillets (flounder), frozen coated flounder fillets, coating ingredients, and the processing environment. Isolation of strains covered the period of a sanitization program introduced in the plant. L. monocytogenes was identified using conventional microbiological methods and the PCR technique. RAPD (random amplified polymorphic DNA) technique for fingerprinting was applied to analyze the intraspecies diversity. Six RAPD types (A \u2013 F) and seven unique strains were revealed as a result of fingerprinting with one persistent type isolated from July 1999 to February 2000. It was detected for the first time after one month of sanitization. Its occurrence could have been promoted by clone selection either due to ineffective disinfection or to resistance against the disinfectant. As L. monocytogenes mostly occurred on frozen products, this indicates that contamination could start during product freezing, cold storage, or handling. The results revealed that there is a crucial need for preparing sanitization schemes precisely targeted at L. monocytogenes to avoid its recurrence as persistent \u2018in \u2013 house' strains. The possibility of incorrect interpretations of classical microbiological test results as well as the necessity to introduce assays based on nucleic acid analysis into epidemiological investigations were emphasized

Nonsteroidal anti-inflammatory drug hypersensitivity syndrome. A multicenter study I. clinical findings and in vitro diagnosis

ackground: We present the results obtained from the largest series of in vitro diagnostic tests ever reported in patients with clinically validated hypersensitivity to acetylsalicylic acid (ASA)/nonsteroidal anti-infl ammatory drugs (NSAID) compared with various categories of controls tolerating ASA/NSAIDs. This multicenter study, which was performed within the framework of the European Network for Drug Allergy (ENDA) group, showed that the basophil activation test (BAT), particularly when used with the 3 NSAIDs aspirin (ASA), diclofenac (DIC), and naproxen (NAP), allows us to confi rm the diagnosis of NSAID hypersensitivity syndrome. The results of the cellular allergen stimulation test (CAST) frequently correlate with those of the BAT, although not always. An unexpected fi nding was that basophil activation by NSAIDs is not an all-or-nothing phenomenon restricted to clinically hypersensitive patients, but that it also occurs in a dose-related manner in some NSAID-tolerant control individuals. Therefore, NSAID hypersensitivity appears as a shift in the normal pharmacological response to NSAIDs. These fi ndings allow us to formulate a new rational hypothesis about the mechanism of NSAID hypersensitivity syndrome, a mechanism that most authors continue to describe as “unknown.” Methods: We enrolled 152 patients with a history of hypersensitivity to NSAIDs and 136 control participants in 11 different centers between spring 2003 and spring 2006. Flowcytometric BAT was performed. Results: The most noteworthy results of our study were that 57% of 140 patients presented very clear-cut positive BAT results to multiple NSAIDs, and 16% were entirely negative. In about 27% of cases, positive results were obtained with 1 or 2 concentrations of a single NSAID. There is clearly a correlation between the results of BAT and CAST. Conclusions: BAT seems particularly indicated in patients with a clinical history of NSAID intolerance, and in whom a provocation test is not advisable for ethical, clinical, or other reasons