Allergy to muscle relaxants and related compounds

Abstract

Anaphylaxis and anaphylactoid reactions are well known side effects of the administration of muscle relaxants to patients undergoing general anaesthesia. Researchers have determined that quaternary ammonium ions on the muscle relaxant molecules bind to drug reactive IgE antibodies and this initiates the release of histamine from the leucocytes. The drug reactive IgE antibodies are not specific and cross react with other muscle relaxants, all of which possess quaternary ammonium ions.Although the mechanism of muscle relaxantinduced anaphylactoid reactions is becoming better understood, the reasons why only some people are allergic to muscle relaxants are not. Sensitisation may occur in patients who have undergone general anaesthesia on more than 1 occasion previously. Further, the presence of ammonium ions on molecules other than those of muscle relaxant drugs (such as vasodilators) may have caused sensitisation in some patients. As yet, the roles, if any, of atopy, spasmophilia, anxiety, gender and increased reactivity to histamine in predisposing patients to muscle relaxant-induced anaphylactoid reactions are largely undetermined.

Anaphylaxis to Muscle Relaxants: An Audit of Ten Years of Allergy Testing at the Royal Adelaide Hospital

“…The most common drug group implicated is muscle relaxants [1][2][3]8,11,[13][14][15][16][17] . The frequency of anaphylaxis with any drug is related to the amount of exposure and the allergenic tendency of that drug.…”

“…The incidence of anaphylaxis to anaesthetic drugs in Australia is estimated as 1:10,000-1:20,000 anaesthetics 2 , but is reported more frequently, at about 1:5000 anaesthetics, in some other countries 1,[8][9][10] . Anaphylaxis is an event anaesthetists are likely to see only occasionally during their career, although it is important as, even when appropriately treated, it has a mortality of up to 10% 1,[9][10][11][12][13][14] .…”

Skin Reactions to Intradermal Neuromuscular Blocking Agent Injections

“…36 This is probably why the performance of skin tests for the diagnosis of sensitization against NMBAs has been considered as excellent by most of the authors. 1,2,5,7,9,[11][12][13]15,17,18,21,37,38 Indeed, the diagnostic value of an intradermal test in patients having presented with a suspected IgE-mediated immediate hypersensitivity reaction during anesthesia was established many years ago using Prausnitz-Kustner testing in human subjects. 11,37,39 Its excellent reproducibility 10 as well as persistence of positivity with time 10,40,41 has also been confirmed.…”

Aktuelni problemi u primeni misicnih relaksanata u klinickoj praksi

“…Za ovu Cinjenicu se znalo vee vrlo brzo posle njihovog uvodenja u klinicku praksu (9). Neki autori smatraju da je upotreba misienih relaksanata odgovorna za vise od 50% nezeljenih posledica koje se javljaju u toku opste anestezije (10).…”