A B S T R A C T Idiopathic reactions occurring during the infusion of hyperosmolar solutions, such as radiocontrast dyes, cause a significant number ofdeaths each year. These reactions are similar to those which follow mediator release during allergen-induced anaphylaxis. In attempting to explain these nonimmunologic reactions, we examined the direct effect of hyperosmolarity on normal human basophils with emphasis on release induced by mannitol.The cells of all donors released histamine in vitro in response to hyperosmolar (0.2-0.7 M) solutions of a number ofsolutes including mannitol. That this was not a toxic Etocess was supported by a number of criteria, including inhibition of release by excess stimulus at 370C and a lack of release at 4°C. Furthermore, electron microscopic studies revealed that hyperosmolar stimulation did not disrupt the cell membrane or lead to any signs of cytotoxicity. In contrast to antigen-stimulated release, where granules fuse only with the cell membrane, granules in mannitol-stimulated cells, in addition to fusing with the cell membrane, may also be extruded into a common intracellular sac before exteriorization.Characteristics similar to antigen-induced histamine release included the time-course for release, inhibition by drugs that modify phospholipid metabolism, p-bromophenacyl bromide, and eicbsa-5,8, 11,14-tetraynoic acid, and augmentation of release by deuterium oxide (D20). The release process differed from antigen-induced release by a number of criteria, including independence from immunoglobulin (Ig)Erelated mechanisms, insensitivity to agonists that ele-