Hypersensitive adverse drug reactions to glucosamine and chondroitin preparations in Australia between 2000 and 2011

Abstract

Purpose of the studyThis study investigates spontaneous adverse drug reactions (ADRs) to glucosamine and chondroitin in the Australian population between 2000 and 2011, with a primary focus on hypersensitivity reactions.Study designCase reports of ADR to glucosamine and chondroitin sent to the Therapeutic Goods Administration between 2000 and 2011 were obtained and analysed. The demographic information and severity of the ADR were recorded for individual ADR cases. These reactions were classified according to the Brown et al grading system for generalised hypersensitivity reactions. This included mild hypersensitivity reactions (generalised erythema, urticaria and angioedema) through to moderate hypersensitivity reactions (wheeze, nausea, vomiting, dizziness (presyncope), diaphoresis, chest or throat tightness and abdominal pain), and more severe reactions (hypotension, confusion and collapse).ResultsIn this study of 366 ADRs to glucosamine and chondroitin preparations, 71.85% of cases (n=263) were found to have hypersensitivity reactions. Of these 263 cases, 92 cases were classified as mild (eg, pruritus, urticaria and lip oedema), 128 cases classified as moderate (such as dyspnoea, nausea and abdominal pain), and 43 cases classified as severe (including amnesia, gait disturbance, somnolence and hypotension). It is not clear whether the patients involved had a known shellfish allergy or underlying atopy.ConclusionResults of this investigation support the need for clear labelling on glucosamine and chondroitin preparations to raise awareness of possible adverse events for those predisposed to allergy or atopy in response to shellfish.

Delayed Skin Allergy to Glucosamine Chondroitin Supplement

“…The mechanism underlying delayed skin allergic reactions to glucosamine chondroitin is not yet fully understood. As a supplement derived from shellfish, shrimp, and crab exoskeletons, glucosamine chondroitin may induce an immune response and subsequent allergic reaction in individuals with a sensitivity or allergy to shellfish [5]. However, the patient in this case reported having no known shellfish allergies.…”

“…Glucosamine chondroitin may also potentially interact with immune cells, such as basophils, which mediate allergic reactions, inducing the release of histamine and other inflammatory mediators that can result in a hypersensitivity rash. The components of glucosamine chondroitin supplements are complex, and the specific components responsible for adverse reactions remain unclear [5]. Glucosamine and chondroitin formulations should explicitly indicate any potential negative effects on individuals prone to shellfish allergies or atopy [5].…”

“…While glucosamine chondroitin is generally well tolerated, adverse reactions and allergies to this supplement have previously been reported in the medical literature [5]. Epigastric discomfort (3.5%), heartburn (2.7%), diarrhea (2.5%), and nausea (1%) are the most prevalent adverse events [6].…”

“…Epigastric discomfort (3.5%), heartburn (2.7%), diarrhea (2.5%), and nausea (1%) are the most prevalent adverse events [6]. More serious but rare adverse effects include allergic reactions which may present as itching, hives, and swelling [5]. There have also been a small number of case reports of severe allergic reactions, including anaphylaxis [5].…”

“…More serious but rare adverse effects include allergic reactions which may present as itching, hives, and swelling [5]. There have also been a small number of case reports of severe allergic reactions, including anaphylaxis [5]. Further, delayed-onset allergic reactions to glucosamine chondroitin, particularly isolated skin rashes, have rarely been described.…”