Prevalence of IgE antibodies to morphine. Relation to the high and low incidences of NMBA anaphylaxis in Norway and Sweden, respectively

Florvaag, Erik; Johansson, S. G. O.; Öman, H.; Venemalm, Lennart; Degerbeck, F.; Dybendal, T.; Lundberg, María

doi:10.1111/j.1399-6576.2004.00591.x

Cited by 145 publications

(118 citation statements)

References 18 publications

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“…(7) To assist anaesthetists to provide appropriate information to the specialist centre. (8) To make recommendations about the reporting and collection of data on anaesthetic anaphylaxis in Great Britain and Ireland.…”

Section: Objectivesmentioning

confidence: 99%

“…The prevalence of anaphylactic reactions to neuromuscular blocking agents (NMBAs) is reported to be at least six times more frequent in some countries [7,8]: it is considerably more common in Norway than in Sweden. Quaternary ammonium ions (QAI) are proposed to be the allergenic epitopes in NMBAs.…”

Section: Possible Environmental Sensitising Agentsmentioning

confidence: 99%

“…Quaternary ammonium ions (QAI) are proposed to be the allergenic epitopes in NMBAs. Common environmental chemicals such as toothpastes, washing detergents, shampoos, and cough medicines share these allergenic epitopes with the NMBAs [8]. Numerous possibilities exist for a predisposed individual to become sensitised to QAIs and thus be at risk of developing anaphylaxis to NMBAs during anaesthesia.…”

Section: Possible Environmental Sensitising Agentsmentioning

confidence: 99%

“…Numerous possibilities exist for a predisposed individual to become sensitised to QAIs and thus be at risk of developing anaphylaxis to NMBAs during anaesthesia. In a recent Scandinavian survey, use of certain cough medicines was found to be the only significant difference in environmental chemical exposure [8]. In Norway, but not Sweden, cough syrups containing pholcodine are available without prescription.…”

Section: Possible Environmental Sensitising Agentsmentioning

confidence: 99%

See 3 more Smart Citations

Suspected Anaphylactic Reactions Associated with Anaesthesia

Harper¹,

Dixon²,

Dugué³

et al. 2009

Anaesthesia

299

151

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Section: Objectivesmentioning

confidence: 99%

Section: Possible Environmental Sensitising Agentsmentioning

confidence: 99%

Section: Possible Environmental Sensitising Agentsmentioning

confidence: 99%

Section: Possible Environmental Sensitising Agentsmentioning

confidence: 99%

See 2 more Smart Citations

Suspected Anaphylactic Reactions Associated with Anaesthesia

Harper¹,

Dixon²,

Dugué³

et al. 2009

Anaesthesia

299

151

View full text Add to dashboard Cite

“…There are currently no NMBA-specific IgE assays readily available, except for suxamethonium (Phadia c202). Unfortunately, on several occasions, sIgE for suxamethonium has been reported to be too insensitive (sensitivity 30-60%) (15,56,57). Different authors have proposed to use a quaternary ammonium (choline chloride) (9,14,(58)(59)(60), a p-aminophenylphosphoryl-choline (15, 61), or morphine-based solid phase sIgE (15,56) assay in preference to different NMBA-specific IgE assays to assess sensitization from quaternary ammonium determinants of NMBA.…”

Section: Neuromuscular Blocking Agentsmentioning

confidence: 99%

Anaphylaxis during anaesthesia: diagnostic approach

Ebo¹,

Fisher²,

Hagendorens³

et al. 2007

Allergy

195

197

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Anaesthesiologists administer several drugs while providing general anaesthesia. Many of these drugs can elicit adverse drug reactions that fall apart into two major types. First, reactions that are usually dose-dependent and related to the pharmacological properties of the drug and/or its metabolites. Second, reactions that are unrelated to the drug's pharmacological characteristics and that are less dose-dependent. These reactions comprise drug intolerance, idiosyncratic reactions and drug-induced immune-mediated allergic and nonimmune-mediated so-called pseudo-allergic or anaphylactoid reactions. The terms anaphylactic and anaphylactoid, however, have been used inconsistently in the literature. Therefore, the nomenclature task force set up by the European Academy of Allergy and Immunology (EAACI) has proposed that anaphylactic-type reactions should be reclassified into allergic anaphylaxis and nonallergic anaphylaxis. Allergic anaphylaxis being further subdivided in IgE-mediated and non-IgE-mediated reactions (1).The exact prevalence of anaphylaxis during anaesthesia is difficult to ascertain. The estimated overall frequency has been reported to vary between 1 in 3500 and 1 in 13 000 procedures in French series (2, 3) and between 1 in 10 000 and 1 in 20 000 in an Australian study (4). The clinical manifestation of these reactions is not infrequently an almost immediate generalized response with bronchospasm and hypotension. The degree of severity varies and does not allow differentiation between an IgE-mediated or non-IgE mediated reaction resulting from nonspecific mediator release (5). The mortality from these reactions is in the range from 3 to 6%, and an additional 2% of patients experience significant residual brain damage (4).Diagnosis of anaphylaxis during anaesthesia is not always straightforward. It can be hampered as a broad spectrum of different drugs can elicit heterogeneous allergic and nonallergic reactions with distinct and sometimes unclear pathological mechanisms. Problems are certainly compounded as multiple drugs need to be administered during general anaesthesia. In addition, nonanaesthesia related drugs or procedures (e.g. disinfection) are sometimes administered/performed in the perioperative period and can also be the cause of an allergic reaction.In addition, none of the available diagnostic tests demonstrates absolute accuracy. False-positive test Correct management of anaphylaxis during anaesthesia requires a multidisciplinary approach with prompt recognition and treatment of the acute event by the attending anaesthesiologist, and subsequent determination of the responsible agent(s) with strict avoidance of subsequent administration of all incriminated and/or cross-reacting compounds.However, correct identification of the causative compound(s) and safe alternatives is not always straightforward and, too often, not done.This review is not intended to discuss acute management of anaesthesia-related anaphylaxis but summarizes the major causes of anaphylaxis during anaesthesia and the di...

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IgE‐mediated allergy to pholcodine and cross‐reactivity to neuromuscular blocking agents: Lessons from flow cytometry

Leysen

Witte

Sabato

et al. 2013

Cytometry Part B Clinical

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Background: Immunoglubulin E antibody-mediated allergic reactions to opioids are rare and difficult to document correctly.Objective: Assessment of the basophil activation test in the diagnosis of IgE-mediated allergy to the antitussive pholcodine and associated sensitizations to neuromuscular blocking agents (NMBA).Methods: Three patients with a suspected IgE-mediated allergy to pholcodine were investigated using skin tests, quantification of specific IgE, and flow cytometric activation of basophils.Results and conclusion: Flow cytometric activation of basophils, with simultaneous analysis of CD63 appearance and median histamine content per cell, is the only technique capable to correctly document pholcodine allergy. The negative predictive value of basophil activation tests might help to elucidate on the controversial putative cross-reactivity between pholcodine and NMBA. V C 2013 International Clinical

show abstract

Prevalence of IgE antibodies to morphine. Relation to the high and low incidences of NMBA anaphylaxis in Norway and Sweden, respectively

Abstract: IgE-sensitization to SUX, MOR and PHO was detected in Norway but not in Sweden. One possible explanation is the unrestricted use of cough mixtures containing MOR derivatives in Norway.

Cited by 145 publications

References 18 publications

Suspected Anaphylactic Reactions Associated with Anaesthesia

Suspected Anaphylactic Reactions Associated with Anaesthesia

Anaphylaxis during anaesthesia: diagnostic approach

IgE‐mediated allergy to pholcodine and cross‐reactivity to neuromuscular blocking agents: Lessons from flow cytometry

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