Perioperative Medicine  |   May 2017
In Vivo Cysteinyl Leukotriene Release in Allergic and Nonallergic Immediate Hypersensitivity Reactions during Anesthesia
Author Notes
  • From the Laboratory of Hormonology (D.L.) and Laboratory of Immunology and Immunopathology (D.M., B.L.M.), Pôle Biologie, Caen University Hospital, Caen, France; Department of Anesthesiology and Critical Care Medicine, Pôle Santé Léonard De Vinci, Tours, France (P.L.); Department of Allergology, Pôle Médecine, Caen University Hospital, Caen, France (Y.O.); Department of Anesthesiology and Intensive Care, Pôle Réanimations Anesthésie Service d’Aide Médicale Urgente, Caen University Hospital, Caen, France (J.-L.H.); Department of Clinical Research and Biostatistics, Pôle Recherche et Epidémiologie Clinique, Caen University Hospital, Caen, France (J.-J.P.); Equipe d’Accueil (EA) 4650, Université Caen Normandie, Unité de Formation et de Recherche de Médecine, Caen, France (J.-L.H.); French National Institute of Health and Medical Research (INSERM), U919, Serine Proteases and Pathophysiology of the Neurovascular Unit, and UMR CNRS 6232 Ci-NAPs, Cyceron, Caen, France (B.L.M.); and EA 2656, Université Caen Normandie, Unité de Formation et de Recherche de Médecine, Caen, France (J.-J.P.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Part of the work presented in this article was previously presented at the American Society of Anesthesiologists Annual Meeting in Orlando, Florida, October 18–22, 2008. The whole work was presented at the 30th Congress of the European Academy of Allergy and Clinical Immunology in Istanbul, Turkey, June 11–15, 2011. This work is attributed to the Laboratories of Hormonology, of Immunology, of Biostatistics, to the Service of Internal Medicine and to the Department of Anesthesia, University Hospital, Caen, France.
    Part of the work presented in this article was previously presented at the American Society of Anesthesiologists Annual Meeting in Orlando, Florida, October 18–22, 2008. The whole work was presented at the 30th Congress of the European Academy of Allergy and Clinical Immunology in Istanbul, Turkey, June 11–15, 2011. This work is attributed to the Laboratories of Hormonology, of Immunology, of Biostatistics, to the Service of Internal Medicine and to the Department of Anesthesia, University Hospital, Caen, France.×
  • Submitted for publication July 25, 2016. Accepted for publication February 3, 2017.
    Submitted for publication July 25, 2016. Accepted for publication February 3, 2017.×
  • Address correspondence to Dr. Laroche: Laboratoire d’Hormonologie, CHU de Caen, F-14033 Caen Cedex 9, France. dominiquelaroche100@orange.fr. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Cardiovascular Anesthesia / Critical Care / Neuromuscular Diseases and Drugs / Respiratory System
Perioperative Medicine   |   May 2017
In Vivo Cysteinyl Leukotriene Release in Allergic and Nonallergic Immediate Hypersensitivity Reactions during Anesthesia
Anesthesiology 5 2017, Vol.126, 834-841. doi:10.1097/ALN.0000000000001600
Anesthesiology 5 2017, Vol.126, 834-841. doi:10.1097/ALN.0000000000001600
Abstract

Background: Immediate hypersensitivity reactions occurring during anesthesia are classified as allergic when skin tests and mast cell tryptase are positive and as nonallergic when negative results are obtained. Cysteinyl leukotrienes (cysLTs) are potent mediators synthesized by mast cell and eosinophil that induce bronchial constriction. They could play a role in hypersensitivity reactions.

Methods: cysLT C4, D4, and E4 concentrations were measured by a competition immunoassay in serial plasma samples obtained prospectively from 21 anesthetized controls and retrospectively from 34 patients who reacted at induction of anesthesia (24 with allergic and 10 with nonallergic reactions).

Results: In controls, the median (interquartile range) cysLT concentration was 0.83 (0.69 to 1.02) μg/l before anesthesia and was unchanged 30 min, 6 h, and 24 h afterward. In the patients with allergic reactions, the values were highly increased 30 to 60 min after the reaction (17.9 [7.8 to 36.0] μg/l), while the patients with nonallergic reactions had less increased values (7.3 [3.0 to 11.5] μg/l). The difference between the three groups was significant (P < 0.0001). Increased values persisted during the 24 h of observation. Concentrations were significantly higher in patients with bronchospasm (P = 0.016).

Conclusions: cysLTs appear to be an important mediator of allergic and nonallergic immediate hypersensitivity reactions. These findings might open a new field for management of patients with hypersensitivity reactions, especially nonallergic ones.