Allergic reaction to hyaluronidase after retrobulbar anaesthesia: a case series and review

Delaere, Lien; Zeyen, Thierry; Foets, Beatrijs; Calster, Joachim Van; Stalmans, Ingeborg

doi:10.1007/s10792-008-9258-7

Cited by 37 publications

(33 citation statements)

References 27 publications

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“…Delaere et al 34 reported cases of probable allergy that responded quickly to corticosteroid treatment. Eberhart et al 35 reported three cases of angioedema following the use of hyaluronidase.…”

Section: Adverse Effects On the Eyementioning

confidence: 99%

Adjuvants to local anaesthesia in ophthalmic surgery

Adams

2011

British Journal of Ophthalmology

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This article reviews the use of adjuvants to local anaesthesia for ophthalmic regional anaesthesia. Hyaluronidase, bicarbonate, epinephrine, muscle relaxants, opiates and clonidine have all been described singly and in combination for use as an adjuvant to ophthalmic regional anaesthesia. The article focuses on the efficacy of the adjuvants with regard to improving akinesia, analgesia, speed of onset and reducing block failure. A description of the pharmacological action of each adjuvant is given followed by a review of randomised control trials, dosage and notable papers on the subject. There is no effective consensus between anaesthetists or surgeons on the use of adjuvants to local anaesthesia and it so is the purpose of this review to draw attention to the wealth of current data and allow an informed decision on the choices available.

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Section: Adverse Effects On the Eyementioning

confidence: 99%

Adjuvants to local anaesthesia in ophthalmic surgery

Adams

2011

British Journal of Ophthalmology

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“…The initial manifestations were influenced by the route of administration: when given at a local site, localized angioedema or urticaria developed;6,10,11 when given intravenously, most patients presented with anaphylactic shock, urticaria, or dyspnea 3. Our patient was administered hyaluronidase via an intrathecal route at a relatively high dose of 1,500 IU.…”

Section: Discussionmentioning

confidence: 88%

“…However, the cumulative dose is not related to clinical manifestations 3. Most of the patients with hyaluronidase allergy had a positive skin prick test or intradermal test 6,10. When hyaluronidase is supposed to be administrated at high-dose hyaluronidase via intravenous or intrathecal routes, skin prick test could be a useful way to predict systemic allergic reactions.…”

Section: Discussionmentioning

confidence: 99%

Acute urticaria caused by the injection of goat-derived hyaluronidase

Kim

Choi

et al. 2009

Allergy Asthma Immunol Res

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Hyaluronidase is a goat testicular protein that hydrolyzes hyaluronic acid, a structural component of the intercellular matrix. It is commonly used as a spreading factor to improve the diffusion of drugs, including local anesthetics and chemotherapeutics. We experienced a 55-yr-old female with generalized urticaria that developed within 1 hr after the epidural injection of hyaluronidase. She had a history of allergic rhinitis, and had suffered from post-herpetic neuralgia and a herniated disc for several years. To relieve her pain, she had been given epidural injections consisting of mepivacaine hydrochloride, triamcinolone acetonide, and morphine sulfate biweekly for one year. Hyaluronidase had been administered several times with these drugs before this episode of generalized urticaria. Skin prick testing showed a positive response to 1,500 IU/mL of hyaluronidase extract, as compared to histamine. The patient's serum hyaluronidase-specific IgE level, determined using an enzyme-linked immunosorbent assay (ELISA), was markedly elevated, as compared to unexposed healthy controls. An IgE immunoblot analysis using hyaluronidase extract and the patient's serum showed IgE binding components at 31 and 21 kDa, whereas no corresponding IgE binding component was found in healthy controls. An ELISA inhibition test showed significant, dose-dependent inhibition with the serial addition of hyaluronidase extract. This is the first case of an IgE-medicated allergic reaction to goat (Naemorhedus goral raddenus) hyaluronidase, demonstrated by skin testing and a specific IgE and immunoblot assay.

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“…5 Additionally, when patients are found to be allergic exclusively to hyaluronidase, the reaction is often localized. The clinical picture is often cloudy: patients do not know to which type of bee they are allergic or to what component of the venom.…”

Section: Discussionmentioning

confidence: 99%

“…3 The honeybee, Apis mellifera (Api-m), has 10 known allergenic substances ( Table 2). 5 A review of the dermatologic literature did not reveal any cases of anaphylaxis or allergy to hyaluronidase. 4 The YJ, Vespula vulgaris (Ves-v), has 5 known allergenic substances.…”

Section: Venom Classificationmentioning

confidence: 97%