A reply


We thank Drs Platt, and colleagues for their correspondence, which has raised important points. We would like to apologise for our error in revision that wrongly quoted the findings of Clarke et al. [1].

We agree that extrapolation of our findings to the treatment of anaphylaxis in humans is not possible. We designed this study merely to investigate the effect of sugammadex and rocuronium on the number and degranulation of mast cells in the rat liver [2], an objective stressed repeatedly throughout the manuscript. The final sentence of the summary, that ‘sugammadex may prove beneficial in treatment of rocuronium-induced anaphylaxis’ is merely a suggestion for further studies on the effect of sugammadex on rocuronium-induced anaphylaxis.

In addressing the specific points raised: ether anaesthesia and positive-pressure ventilation were received not only by group R, but also by groups RS15 and RS100. All rats were given ether euthanasia. Toluidine blue staining was used to detect intact and degranulated tissue mast cells, and release of cellular granules [3]. Tryptase, a natural protease released during mast cell degranulation and detected using streptovidin-biotin-peroxidase staining [4], was used to increase the accuracy in detection of degranulated mast cells. It is worth mentioning that measurement of serum tryptase levels and total, or specific, IgE levels may prove beneficial in detecting mast cell activation and degranulation [5]. These limitations were mentioned in the discussion section of our study.

Finally, it is known that mast cell precursors originating from the bone marrow migrate in the bloodstream and into target connective tissues, where they proliferate further and differentiate into tissue mast cells. A portion of these mast cells function as localised mast cell precursors. In situations of increased demand for local production of mast cells, these localised mast cell precursors with proliferative potentiality quickly respond [6]. Therefore, the increase in tissue mast cell numbers may occur within hours. Further demand is met by migration and differentiation of mast cell precursors from the bone marrow, which may take days.