Diagnostic accuracy of the passive mast cell activation test in neuromuscular blocking agent-induced perioperative anaphylaxis in a tertiary hospital in China: a diagnostic accuracy study
Abstract
Objectives: The passive mast cell activation test (pMAT) is a novel in vitro assay designed to complement existing tools like the skin test (ST) and basophil activation test (BAT) for allergen identification. This study aimed to validate the diagnostic accuracy of pMAT specifically for neuromuscular blocking agent (NMBA)-induced perioperative anaphylaxis (POA).
Design: A diagnostic accuracy study.
Setting: A tertiary hospital in Beijing, China.
Participants: 44 patients with suspected POA were enrolled. Participants were stratified into groups based on ST and/or BAT. The NMBA-allergic group comprised 15 patients with confirmed NMBA allergy while the non-NMBA-allergic group consisted of 29 individuals without NMBA allergy.
Interventions: All participants underwent pMAT testing for relevant NMBA.
Primary and secondary outcome measures: The diagnostic performance of pMAT for NMBA was assessed by measuring sensitivity, specificity, likelihood ratios and the Youden index. An exploratory analysis evaluated its performance in diagnosing antibiotic-induced allergies within the same population.
Results: For NMBA allergy, pMAT demonstrated high diagnostic accuracy (90.9%; 95% CI 77.4% to 97.1%) with excellent sensitivity (93.3%; 95% CI 66.0% to 99.7%) and specificity (89.7%; 95% CI 71.5% to 97.3%). This was reflected in a high positive likelihood ratio (9.05; 95% CI 3.06 to 26.57), a low negative likelihood ratio (0.07; 95% CI 0.01 to 0.50), a Youden index of 0.83 and a Cohen's kappa…
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