• Dominique Laroche, Pierre Léturgie, Delphine Mariotte, Yann Ollivier, Jean-Luc Hanouz, Brigitte Le Mauff, and Jean-Jacques Parienti.
• 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.).
• Anesthesiology. 2017 May 1; 126 (5): 834-841.

BackgroundImmediate 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.MethodscysLT 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).ResultsIn 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).ConclusionscysLTs 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.

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