Choc anaphylactoïde mortel chez un malade traité par bêta-bloquants

Do β-blockers really enhance the risk of anaphylaxis during immunotherapy?

“…This study provides information that pertains to the additional two questions regarding -blocker risk: are severe reactions more frequent, and are they more likely to be refractory to management? These data imply that patients receiving -blockers are at elevated risk for both, and are consistent with previous reports of unusually severe anaphylaxis occurring in patients receiving -blockers [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31].…”

“…Newman and Schultz [17] reported a similar case. Additional cases of unusually severe anaphylaxis in patients receiving -blockers have also been described [18][19][20][21][22][23][24][25][26][27][28][29][30][31]. In 1986, two fatal anaphylactic reactions to penicillin were reported.…”

“…However, the relative advantage of "cardioselective" -blockers with respect to enhanced risk for anaphylaxis is uncertain. The contention that greater risk for more serious anaphylaxis extends to "cardioselective" -blockers is supported by reports of unusually severe anaphylaxis in association with 1 -selective antagonists [19,20,21,28] and in vitro histamine release demonstrated with either 1 or 2 antagonists [50,51]. Until more data are available, absence of increased risk for potentiated anaphylaxis with use of selective -blockers cannot be assumed.…”

Use of β-blockers during immunotherapy for Hymenoptera venom allergy

“…Theoretical and clinical evidence for a risk of severe and difficult to treat allergic reactions favored by the use of BB during IT is certainly strong. [1][2][3][4][5][6][7][8][9][10][11][12][28][29][30][31] However, when confronted with a patient with a history of severe allergic sting reactions who is on BB, we have to estimate the risk of giving the BB during VIT against the risk of stopping the BB in the presence of cardiovascular disease or even the risk of renouncing VIT and continuing the BB. The significantly prolonged survival of patients with CHD or cardiac failure under BB treatment, 13-15 the high frequency of deaths caused by cardiovascular disease-in Switzerland every year, more than 25,000 compared, with an average of 3 caused by Hymenoptera sting anaphylaxis 36 -and the exposure of the patient to further stings and the nature of the cardiovascular disease must be considered in this situation, preferably together with the family practitioner and a cardiologist.…”

“…Several reports of severe, difficult-to-treat, or even fatal anaphylaxis in patients on b-blocker (BB) treatment [1][2][3][4][5][6] have raised concern about the use of these medications in patients with a history of anaphylaxis. 7,8 Similar observations of severe and difficult-to-treat allergic side effects have been published in patients on specific allergen immunotherapy (SIT) and concurrent b-blockade.…”