cosyntropin and Anaphylaxis

Topics: Anaphylaxis; Cosyntropin; Data Collection; Endocrine Glands; Humans; Laboratories; United Kingdom

Several side effects of drugs observed in an office of a general practitioner are described. The cause of these side effects, their prevention and their treatment are discussed.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Anaphylaxis; Anti-Inflammatory Agents, Non-Steroidal; Cosyntropin; Diclofenac; Digoxin; Drug Eruptions; Drug Hypersensitivity; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Nitrofurantoin; Penicillin G Procaine; Risk Factors; Verapamil

Subsequent use of an adrenocorticotropic hormone (ACTH) preparation may be considered in some instances in a patient who has demonstrated a suspected or proven allergic reaction to corticotropin on prior administration. We describe a patient with multiple sclerosis with a history of anaphylaxis to porcine ACTH in whom another course of treatment with ACTH was being considered. The patient had immediate cutaneous reactivity to porcine ACTH but not to the synthetic ACTH peptide, cosyntropin. With a test-dose schedule, we were able to uneventfully administer cosyntropin to the patient. The presence of serum IgE antibody directed against porcine ACTH and absence of IgE antibody against cosyntropin were demonstrated by ELISA technique, corroborating the skin test results. These studies are consistent with previous evidence that immediate hypersensitivity reactions to corticotropin are IgE mediated and support the value of skin testing in the clinical evaluation and management of known or suspected corticotropin hypersensitivity.

Topics: Adrenocorticotropic Hormone; Adult; Anaphylaxis; Animals; Cosyntropin; Drug Hypersensitivity; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoglobulin E; Skin Tests; Swine

Synthetic 1-24adrenocorticotrophin (tetracosactid, Synacthen) is used in clinical medicine for diagnostic and therapeutic purposes. Side effects may occur due to unphysiological stimulation of endogenous adrenocortical hormone production. Allergic reactions to tetracosactid are rare. Anaphylactic shock leading to death was observed after intravenous injection of tetracosactid in a 14-year-old girl with bronchial asthma. Adrenocorticotrophin antibodies could be demonstrated after death in serum and ascitic fluid using the double antibody method.

Topics: Adolescent; Adrenocorticotropic Hormone; Anaphylaxis; Antibodies; Ascitic Fluid; Asthma; Cosyntropin; Female; Humans

Among 26,462 carefully monitored medical inpatients, 24, or 0.9 per 1,000, were considered to have died as a result of a drug or group of drugs. Most of the patients were seriously ill prior to the event that caused death. Six of the deaths-five from fluid overload and one from excessive potassium therapy-may have been preventable.

Topics: Adolescent; Adult; Aged; Anaphylaxis; Asthma; Cerebral Hemorrhage; Cosyntropin; Drug Therapy; Drug-Related Side Effects and Adverse Reactions; Female; Hemorrhage; Heparin; Hospitalization; Humans; Iatrogenic Disease; Male; Methods; Middle Aged; Pharmaceutical Preparations; Pulmonary Embolism; Streptodornase and Streptokinase; Thrombophlebitis; United States

Topics: Adrenocorticotropic Hormone; Adult; Anaphylaxis; Animals; Antibody Formation; Asthma; Cosyntropin; Drug Hypersensitivity; Drug Therapy, Combination; Humans; Injections, Intramuscular; Male; Swine; Zinc

Topics: Adrenocorticotropic Hormone; Anaphylaxis; Asthma; Cosyntropin; Drug Hypersensitivity; Female; Humans; Male; Middle Aged