Anaphylaxis related to fentanyl citrate

Abstract

Anaphylaxis is a fulminant, unexpected, immunoglobulin E-mediated allergic reaction that can be triggered by multiple agents. Common causative agents include neuromuscular blocking drugs, latex, antibiotics, colloids, hypnotics, and opioids. Fentanyl citrate, however, is an extremely unusual cause of anaphylaxis. Pulmonary edema, although uncommon in anaphylaxis, can be a prominent feature, as was in one of the patient. An adverse drug reaction is a noxious or unintended reaction to a drug that is administered in standard doses by the proper route for the purpose of prophylaxis, diagnosis, or treatment. Reactions are classified into two major subtypes: type A, which are dose dependent and predictable; and type B, which are not dose dependent and unpredictable. Unpredictable reactions include immune (allergic) or no immune drug hypersensitivity reactions and are related to genetic susceptibilities or undefined mechanisms (formally called idiosyncratic and intolerance reactions). A drug allergy is always associated with an immune mechanism for which evidence of drug-specific antibodies or activated T lymphocytes can be shown. In the last few years, many novel drugs have entered clinical practice (i.e., biologic agents) generating novel patterns of drug hypersensitivity reactions. As old drugs continue to be used, new clinical and biologic techniques enable improvement in the diagnosis of these reactions.

Perioperative Anaphylaxis

“…There are few case reports describing fentanyl-related anaphylactic reactions [80][81][82], and IDT was used to investigate the reported cases.…”

Suspect anaphylaxis following intravenous buprenorphine administration in a dog

“…Anaphylactic IgE-mediated and non-IgE-mediated reactions are medical emergencies that involve an unpredictable systemic reaction, potentially fatal, due to the activation of mast cells and basophils (Lorenz and others 1978, Tomar and others 2012, Boggs and others 2013, Shmuel and Cortes 2013). Symptoms commonly affect the skin, respiratory tract and cardiovascular system, but the gastrointestinal system and the CNS may also be involved.…”

“…Opioids are commonly administered in human and small animal patients and they may cause histamine release; however, they rarely cause an anaphylactic reaction (Armitage-Chan 2010, Baldo and Pham 2012, Tomar and others 2012). …”

Neostigmine Anaphylaxis Induced Cardiogenic Pulmonary Edema: Case Report

“…Literatürdeki anafilaksiye bağlı pulmoner ödem tedavisi ile ilgili öneriler randomize kontrollü çalışmalardan ziyade olgu sunularından sağlanmaktadır. 12,13 Neostigmin anafilaksine bağlı kardiyojenik pulmoner ödemi ile ilgili de kanıta dayalı tedavi önerileri bulunmamaktadır. Raper ve Fisher, anafilaksi sonrası miyokard depresyonunda hemodinamik stabiliteyi, intraaortik balon ile sağlamışlardır.…”

“…15,16 Diğer taraftan pulmoner ödeminin tedavisi inotrop destek ve sıvı kısıtlaması ile birlikte ön yük ve ard yükün azaltılmasını içe-rir. 12,17 Bu olguda olduğu gibi her iki durum söz konusu olduğunda sıvı tedavisi dikkatle yapılmalıdır.…”