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An IgG-induced neutrophil activation pathway contributes to human drug-induced anaphylaxis

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Science Translational Medicine  10 Jul 2019:
Vol. 11, Issue 500, eaat1479
DOI: 10.1126/scitranslmed.aat1479

A shocking contributor in drug-induced anaphylaxis

Classic anaphylaxis is thought to depend on IgE engagement of Fc receptors on mast cells and basophils, but allergen-specific IgE is not always present. To resolve this conundrum, Jönsson and colleagues studied samples from people that experienced anaphylaxis after neuromuscular-blocking agent administration. They found that drug-specific IgG complexes could trigger neutrophils ex vivo and anaphylactic patients had increased circulating activated neutrophils. Not all of the patients had detectable antidrug IgE. Their results reveal that alternative pathways may be at play and could help develop tests to reduce risk in anesthetic drug administration.

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