A patient with anaphylactoid hypersensitivity to intravenous cyclosporine and subcutaneous phytonadione (vitamin K1)

Dl, Riegert-Johnson; Kumar, Shaji; Volcheck, GW

doi:10.1038/sj.bmt.1703305

Cited by 9 publications

(7 citation statements)

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“…Some reports have classified these adverse reactions as anaphylactoid reactions [10]. Riegert-Johnson has reported one case of an adverse reaction to VK 1 and concluded that this patient most likely experienced an anaphylactoid (non-IgE-mediated) hypersensitivity reaction [11]. Fiore has defined “anaphylactoid” as an adverse drug event in which at least one of the reported adverse drug reactions includes any of the following CONSTART entries: anaphylaxis, allergic reaction, apnea, death, cardiac arrest, hypotension, shock or vasodilation [2].…”

Section: Introductionmentioning

confidence: 99%

The Severe Adverse Reaction to Vitamin K1 Injection Is Anaphylactoid Reaction but Not Anaphylaxis

Ping

Xiao

et al. 2014

PLoS ONE

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The severe adverse reaction to vitamin K1 injection is always remarkable and is thought to result from anaphylaxis. Paradoxically, however, some patients administered vitamin K1 injection for the first time have adverse reactions. Using beagle dogs, the present study tested the hypothesis that the response to vitamin K1 is an anaphylactoid reaction. The results showed that serious anaphylaxis-like symptoms appeared in beagle dogs after the administration of vitamin K1 injection for the first time. The plasma histamine concentration increased, and blood pressure decreased sharply. After sensitization, dogs were challenged with vitamin K1 injection and displayed the same degree of symptoms as prior to sensitization. However, when the vitamin K1 injection-sensitized dogs were challenged with a vitamin K1-fat emulsion without solubilizers such asTween-80, the abnormal reactions did not occur. Furthermore, there was no significant change in the plasma immunoglobulin E concentration after vitamin K1 challenge. Following treatment with vitamin K1 injection, the release of histamine and β-hexosaminidase by rat basophilic leukemia-2H3 cells as well as the rate of apoptosis increased. The Tween-80 group displayed results similar to those observed following vitamin K1 injection in vivo. However, the dogs in the vitamin K1-fat emulsion group did not display any abnormal behavior or significant change in plasma histamine. Additionally, degranulation and apoptosis did not occur in rat basophilic leukemia-2H3 cells. Our results indicate that the adverse reaction induced by vitamin K1 injection is an anaphylactoid reaction, not anaphylaxis. Vitamin K1 injection induces the release of inflammatory factors via a non-IgE-mediated immune pathway, for which the trigger may be the solubilizer.

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Section: Introductionmentioning

confidence: 99%

The Severe Adverse Reaction to Vitamin K1 Injection Is Anaphylactoid Reaction but Not Anaphylaxis

Ping

Xiao

et al. 2014

PLoS ONE

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“…Recently, the number of severe adverse reactions caused by the intravenous administration of VK 1 has increased and attracted public attention (Fiore et al ., ; Riegert‐Johnson et al ., ). Because VK 1 is a lipid‐soluble substance and is poorly soluble in water, a solubilizer, such as Tween 80, is required to prepare it for injection (Qiu et al ., ).…”

Section: Introductionmentioning

confidence: 97%

Vitamin K₁ distribution following intravenous vitamin K₁–fat emulsion administration in rats

Xiao

Wang³

et al. 2015

Biomedical Chromatography

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This study investigated vitamin K1 (VK1 ) distribution following intravenous vitamin K1-fat emulsion (VK1 -FE) administration and compared it with that after VK1 injection. Rats were intravenously injected with VK1-FE or VK1 . The organ and tissue VK1 concentrations were determined using high-performance liquid chromatography method at 0.5, 2 and 4 h to determine distribution, equilibrium and elimination phases, respectively. In the VK1-FE group, the plasma, heart and spleen VK1 concentrations decreased over time. However, other organs like liver, lung, kidney, muscle and testis, reached peak VK1 concentrations at 2 h. In the VK1 injection group, the liver VK1 concentrations were significantly higher than those in other organs at the three time points. However, VK1 concentrations in the other organs peaked at 2 h. In addition, in VK1-FE group, the heart, spleen and lung VK1 concentrations were significantly higher than those in the VK1 injection group at the three time points, and the liver VK1 concentration was significantly higher than that in the VK1 injection group at 4 h. The VK1 amount was greatest in the liver compared with the other organs. Thus, the liver is the primary organ for VK1 distribution. The distribution of VK1 is more rapid when injected as VK1-FE than as VK1 .

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“…18,26 Of the 10 reactions detailing previous vitamin K1 exposure, 6 had previously received some form of vitamin K1. 25,26,29,30,32 Two cases reported on patients with prior reactions to other medications formulated with PEO-CO. 19,22 Five cases described rechallenge of the patient with vitamin K1 22,23,25,31,32 , 2 of which resulted in recurrence of the reaction. 23,25 Three pediatric patients ranging from newborn to 9 years of age were represented in the case reports ( Table 2).…”

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confidence: 99%

Characterizing the Severe Reactions of Parenteral Vitamin K1

Britt

Brown

2016

Clin Appl Thromb Hemost

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Parenteral vitamin K1 (phytonadione) is used for anticoagulant reversal, and a boxed warning exists with intravenous and intramuscular administration due to the possibility of severe reactions, including fatalities. These reactions resemble hypersensitivity or anaphylaxis, including anaphylactoid reaction, and have led to shock and cardiac and/or respiratory arrest. The objective of this review is to summarize the available literature detailing the anaphylactic/anaphylactoid reactions with parenteral vitamin K1 in order to better characterize the reaction and provide a more in-depth understanding of its importance. A comprehensive literature search of MEDLINE (1946 to June 2016) and EMBASE (1947 to June 2016) was conducted using the terms vitamin K1, phytonadione, phytomenadione, vitamin K group, anaphylaxis, polyoxyethylated castor oil, and cremophor. A total of 2 retrospective surveillance studies, 2 retrospective cohort studies, and 17 case reports were identified for inclusion and assessment. Based on a review of the literature, use of parenteral vitamin K1 may result in severe hypotension, bradycardia or tachycardia, dyspnea, bronchospasm, cardiac arrest, and death. These reactions are most consistent with a nonimmune-mediated anaphylactoid mechanism. It appears that intravenous administration is more frequently associated with these reactions and occurs at an incidence of 3 per 10 000 doses of intravenous vitamin K1. The solubilizer may also increase the risk of adverse reactions, which occurred in patients with and without previous exposure to vitamin K1. Although there are known factors that increase the risk of an adverse drug event occurring, reactions have been reported despite all precautions being properly followed.

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A patient with anaphylactoid hypersensitivity to intravenous cyclosporine and subcutaneous phytonadione (vitamin K1)

Cited by 9 publications

References 4 publications

The Severe Adverse Reaction to Vitamin K1 Injection Is Anaphylactoid Reaction but Not Anaphylaxis

The Severe Adverse Reaction to Vitamin K1 Injection Is Anaphylactoid Reaction but Not Anaphylaxis

Vitamin K₁ distribution following intravenous vitamin K₁–fat emulsion administration in rats

Characterizing the Severe Reactions of Parenteral Vitamin K1

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A patient with anaphylactoid hypersensitivity to intravenous cyclosporine and subcutaneous phytonadione (vitamin K1)

Cited by 9 publications

References 4 publications

The Severe Adverse Reaction to Vitamin K1 Injection Is Anaphylactoid Reaction but Not Anaphylaxis

The Severe Adverse Reaction to Vitamin K1 Injection Is Anaphylactoid Reaction but Not Anaphylaxis

Vitamin K1 distribution following intravenous vitamin K1–fat emulsion administration in rats

Characterizing the Severe Reactions of Parenteral Vitamin K1

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Vitamin K₁ distribution following intravenous vitamin K₁–fat emulsion administration in rats