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There is need for an in vitro diagnostic test for hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs). The purpose of this study was to assess the reliability of one such diagnostic, the basophil activation test. Forty-three drug hypersensitive patients referring several immediate reactions (anaphylaxis, urticaria, angioedema, asthma, and rhinoconjunctivitis) to one or more NSAIDs and 29 controls participated. Using the Basotest commercial kit, 63 determinations were performed with the drugs implicated in the adverse reactions (ASA, ibuprofen, metamizol, diclofenac, paracetamol, and ketorolac). In 16 patients additional determinations were made with other chemically unrelated NSAIDs. Forty-two determinations were made for controls. The analysis was performed by flow colorimetric cytometry and double staining with the monoclonal antibodies anti-IgE and anti-CD63. A Basophil Activation Index (percentage of activated basophils after allergen stimulation/percentage of basally activated basophils) of two or more was considered a positive result. Specificity of 100% and sensitivity of 42.85% were achieved. The positive predictive value was 100%, and the negative predictive value was 53.84%. In 35.29% of intolerant patients there was a positive reaction to at least two drugs implicated in adverse reactions, and in 27.27% of these patients there was a positive reaction to other chemically unrelated NSAIDs. The basophil activation test is useful for the in vitro diagnosis of NSAID hypersensitivity, providing good specificity and positive predictive value and diagnostic reliability in the assessment of NSAID intolerance.

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BACKGROUND AND OBJECTIVE: N-terminal pro-brain natriuretic peptide (NT-proBNP) is a useful predictor of cardiovascular events in patients without clinical evidence of cardiovascular disease. It is unknown if the cardiovascular risk factors control can modify these levels. We studied if atorvastatin treatment decrease NT-proBNP levels in hypercholesterolemic subjects, with and without hypertension. PATIENTS AND METHOD: It was an open, prospective study in 39 patients with hypercholesterolemia without clinical evidence of cardiovascular disease. 15 (38.5%) had hypertension. Blood samples were collected initially and 12 and 24 weeks after beginning treatment with 20 mg of atorvastatin. RESULTS: The median age was 54 years, and 41% were males. NT-proBNP (pg/ml) values were: 193 (294) at baseline; 141 (211) (p < 0.05) after 12 weeks therapy, and 89 (130) (p < 0.01) at 24 weeks. In hypertensive patients value changed from: 275 (388) at baseline, 196 (290) (p < 0.05) and 112 (124) (p < 0.001) after 12 and 24 weeks treatment. And the levels in normotensives patients were: 137 (198) at baseline, 103 (129) (p = NS), and 74 (135) (p < 0.001) at 12 and 24 weeks after treatment with atorvastatin. We didn't find any correlations between the percentage decrease in NT-proBNP levels, and change of total cholesterol, systolic blood pressure, C reactive protein, or nitrites/nitrates blood levels, at 12, and 24 weeks compared to baseline levels. CONCLUSIONS: In middle-aged hypercholesterolemic patients, without evidence of cardiovascular disease, atorvastatin therapy decrease NT-proBNP blood levels, in both hypertensive and normotensives subjects.

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Fundamento y objetivo: La concentración plasmática del propéptido natriurético cerebral N-terminal (NT-proBNP) es útil como predictor de acontecimientos cardiovasculares en la población asintomática. Se desconoce si el control de los factores de riesgo cardiovascular puede modificar dichos valores. Hemos estudiado si el tratamiento con atorvastatina disminuye los valores del NT-proBNP en pacientes hipercolesterolémicos, con hipertensión y sin ella. Pacientes y método: Realizamos un estudio prospectivo y abierto en 39 pacientes con hipercolesterolemia que se hallaban asintomáticos; 15 de ellos (38,5%) eran hipertensos. Se les realizaron extracciones de sangre basal y a las 12 y 24 semanas de tratamiento con 20 mg de atorvastatina. Resultados: La mediana de la edad fue de 54 años y un 41% eran varones. Para el conjunto de la población, los valores medios (desviación estándar) del NT-proBNP (pg/ml) fueron: basal, 193 (294); a las 12 semanas de tratamiento, 141 (211) (p < 0,05), y a las 24 semanas, 89 (130) (p < 0,01). En los pacientes hipertensos, dichos valores fueron: basal, 275 (388); a las 12 semanas, 196 (290) (p < 0,05), y las 24 semanas, 112 (124) (p < 0,001); y en los normotensos: basal, 137 (198); a las 12 semanas, 103 (129) (p = no significativo), y a las 24 semanas, 74 (135) (p < 0,001). No se encontró relación entre el porcentaje de descenso del NT-proBNP y las variaciones del colesterol total, presión arterial sistólica, proteína C reactiva y valores de nitritos/nitratos sanguíneos entre las 12 y 24 semanas respecto a los valores basales. Conclusiones: El tratamiento con atorvastatina en pacientes asintomáticos de mediana edad con hipercolesterolemia disminuye los valores sanguíneos del NT-proBNP tanto en sujetos hipertensos como normotensos

Background and objective: N-terminal pro-brain natriuretic peptide (NT-proBNP) is a useful predictor of cardiovascular events in patients without clinical evidence of cardiovascular disease. It is unknown if the cardiovascular risk factors control can modify these levels. We studied if atorvastatin treatment decrease NT-proBNP levels in hypercholesterolemic subjects, with and without hypertension. Patients and method: It was an open, prospective study in 39 patients with hypercholesterolemia without clinical evidence of cardiovascular disease. 15 (38.5%) had hypertension. Blood samples were collected initially and 12 and 24 weeks after beginning treatment with 20 mg of atorvastatin. Results: The median age was 54 years, and 41% were males. NT-proBNP (pg/ml) values were: 193 (294) at baseline; 141 (211) (p < 0.05) after 12 weeks therapy, and 89 (130) (p < 0.01) at 24 weeks. In hypertensive patients value changed from: 275 (388) at baseline, 196 (290) (p < 0.05) and 112 (124) (p < 0.001) after 12 and 24 weeks treatment. And the levels in normotensives patients were: 137 (198) at baseline, 103 (129) (p = NS), and 74 (135) (p < 0.001) at 12 and 24 weeks after treatment with atorvastatin. We didn't find any correlations between the percentage decrease in NT-proBNP levels, and change of total cholesterol, systolic blood pressure, C reactive protein, or nitrics/nitrates blood levels, at 12, and 24 weeks compared to baseline levels. Conclusions: In middle-aged hypercholesterolemic patients, without evidence of cardiovascular disease, atorvastatin therapy decrease NT-proBNP blood levels, in both hypertensive and normotensives subjects

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