In-vitro-Testverfahren bei Analgetikaintoleranz

Abstract

Acute intolerance reactions to aspirin or nonsteroidal antiinflammatory drugs are referred to as aspirin-exacerbated respiratory disease (AERD), a nonallergic hypersensitivity reaction with potentially anaphylactoid character. AERD is essentially based on a continuous and progressive subclinical airway inflammation, due to an altered arachidonic acid metabolism. Intake of COX-1 inhibitors induces an excessive production of leukotrienes due to an insufficient and dysbalanced production of prostaglandin E 2 . Clinically, the resulting reactions comprise attacks of rhinitis and asthma. Todays gold standard for confirming the diagnosis of AERD is provocation testing with COX-1 inhibitors. However, due to the potentially severe complications resulting from provocation testing, it should only be performed in centers with suitable emergency facilities. Based on the known pathophysiological mechanisms of the disease during the last decade, many attempts have been made to establish a reliable in vitro testing approach to substitute provocation testing. Current assays can be classified according to the underlying methodology: mediator release assays, tests based on flow cytometry, or combinations of these methods. Accordingly, the present article reviews existing mediator release assays: the cellular antigen stimulation test (CAST), the Analgetikaintoleranztest (AIT), and the aspirin-sensitive patients identification test (ASPItest) as well as tests based on flow-cytometric quantification of CD63 expression (CAST-Flow, Basotest), and the hybrid test system CAST-Combi. Based on the most recent data concerning their sensitivity and specificity, the review provides an overview on the current status of this challenging field of in vitro diagnostic testing.