Blood Res 2018; 53(4): 299-306
Neutrophil oxidative burst as a diagnostic indicator of IgG-mediated anaphylaxis
Dong Il Won1, Sujeong Kim2, Eun Hee Lee3
1Department of Clinical Pathology, 2Division of Allergy and Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, 3Green Cross Reference Laboratory, Yongin, Korea
Correspondence to: Dong Il Won, M.D., Ph.D., Department of Clinical Pathology, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea, E-mail:
Received: June 24, 2018; Revised: July 26, 2018; Accepted: July 30, 2018; Published online: December 31, 2018.
© The Korean Journal of Hematology. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
IgG-mediated anaphylaxis occurs after infusion of certain monoclonal antibody-based therapeutics. New in vitro tests are urgently needed to diagnose such reactions. We investigated whether allergens trigger neutrophil oxidative burst (OB) and if neutrophil OB occurs due to allergen-specific IgG (sIgG).
Neutrophil OB was measured by dihydrorhodamine 123 flow cytometry using a leukocyte suspension spiked with a very small patch of the allergen crude extract, Dermatophagoides farinae (Der f). The mean fluorescence intensity ratio of stimulated to unstimulated samples was calculated as the neutrophil oxidative index (NOI).
The Der f-specific NOI (Der f-sNOI) showed a time-dependent increase after Der f extract addition. At 15 min activation, higher Der f-sIgG levels were associated with lower Der f-sNOI values in 31 subjects (P<0.05). This inverse relationship occurs due to the initial blocking effect of free Der f-sIgG. Additionally, neutrophil OB was nearly absent (Der f-sNOI of -1) in two cases: a subject with undetectable Der f-sIgG levels and washed leukocyte suspensions deprived of Der f-sIgG.
Allergens can trigger neutrophil OB via preexisting allergen-sIgG. Neutrophil OB can be easily measured in a leukocyte suspension spiked with the allergen. This assay can be used to diagnose IgG-mediated anaphylaxis.
Keywords: Neutrophils, Oxidative burst, Anaphylaxis, Immunoglobulin G, Dihydrorhodamine 123


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