orabase and Anaphylaxis

Carboxymethylcellulose (CMC) is used extensively in the pharmaceutical and food industries on account of its various properties. Anaphylactic reactions are rare. It has been reported principally after intra-articular infiltration of sustained-release corticosteroids containing CMC and, very rarely, after barium enema.. A case of pre-lethal anaphylactic shock after barium enema was studied by prick-test, intra-dermal reaction (IDR), leukocyte histamine release test (LHRT), basophil activation test (BAT), cystein-leukotriene release test (CAST) and dot-blot analysis.. IDR to CMC was positive at a concentration of 10 microg/ml. BAT and CAST were positive. Specific IgE were identified using dot-blot analysis.. This is the third report of CMC-specific IgE and the second of anaphylaxis to CMC associated with a barium suspension in contact with GI tract mucosa. CMC as an excipient in medicinal products may therefore be a risk factor for severe anaphylaxis after injection or following contact with GI tract mucosa. Sensitization and allergic reactions by CMC in food additives have to be considered.

Topics: Anaphylaxis; Carboxymethylcellulose Sodium; Drug Hypersensitivity; Humans; Immunoglobulin E; Male; Middle Aged

Allergic reactions to various corticosteroids are rare but have been reported previously.. We wished to determine the etiology of an anaphylactic reaction in a patient who had received intracutaneous Kenalog (triamcinolone acetonide).. Skin testing and serologic testing for allergen-specific IgE antibodies was performed for triamcinolone acetonide, its individual components, and three other corticosteroid preparations in both the patient and six other nonallergic persons.. The patient had positive skin tests to only the carboxymethylcellulose component of triamcinolone acetonide. He had negative skin test reactions to three other steroid preparations which did not contain carboxymethylcellulose. Specific IgE antibodies to carboxymethylcellulose were also elevated by immunoassay and immunoblotting. Control patients had negative skin tests to triamcinolone acetonide, its components, and three other corticosteroid preparations, and their sera lacked significant specific IgE antibodies to these materials.. Our results indicate that the triamcinolone acetonide component responsible for the patient's reaction was the suspending agent carboxymethylcellulose. We urge physicians to consider component testing when patients experience allergic-type reactions to drugs.

Topics: Adult; Anaphylaxis; Carboxymethylcellulose Sodium; Humans; Immunoglobulin E; Male; Skin Tests; Triamcinolone Acetonide

Excipients are widely used in pharmaceuticals, detergents, food, and drink because of their properties of low toxicity and hypoallergenicity. The excipient carboxymethylcellulose is used extensively as a thickener in foods such as baked goods, ice cream, gluten free, and reduced fat products, where it may be labeled as e-number E466. However, excipients can rarely cause type 1 hypersensitivity reactions. Several publications have described systemic allergy following carboxymethylcellulose exposure in pharmaceuticals, particularly systemic corticosteroids. Furthermore, there is one reported case in the literature of anaphylaxis following food containing carboxymethylcellulose.. We identify a case of anaphylaxis in a 45-year-old atopic Caucasian woman on receiving an injectable suspension of the corticosteroid triamcinolone acetonide containing carboxymethylcellulose, and subsequent allergic symptoms on reexposure to carboxymethylcellulose in a commercial drink. Diagnosis of carboxymethylcellulose excipient allergy was confirmed through skin prick testing using Celluvisc carmellose 0.5% eye drops, which contain carboxymethylcellulose as the active ingredient.. This case highlights the importance of identifying excipients such as carboxymethylcellulose as causes of allergy, to reduce burden of further hypersensitivity reactions, not just to drugs but to other consumables.

Topics: Anaphylaxis; Carboxymethylcellulose Sodium; Drug Hypersensitivity; Excipients; Female; Humans; Middle Aged; Skin Tests

Topics: Anaphylaxis; Carboxymethylcellulose Sodium; Humans; Ice Cream; Mastocytosis

Topics: Aged; Anaphylaxis; Carboxymethylcellulose Sodium; Female; Glucocorticoids; Humans; Injections, Intra-Articular; Pharmaceutic Aids; Shoulder Pain; Skin Tests; Triamcinolone Acetonide

A 14-year-old girl developed 4 episodes of anaphylaxis of unknown etiology, which required intramuscular adrenaline administration each time. She had eaten pizza and a cheeseburger immediately before the first 2 episodes, respectively, but had not eaten anything for several hours before the last 2 episodes. It turned out that she had eaten the same ice lolly 4 hours before the first 3 episodes and a Café au lait Swirkle (a half-frozen beverage) 4 hours before the last episode. We detected carboxymethylcellulose sodium as the only common ingredient in all anaphylactic episodes. Skin prick tests were positive for carboxymethylcellulose solution and carboxymethylcellulose-containing food products. We obtained a custom-made carboxymethylcellulose sodium-free ice lolly from the manufacturer and confirmed that it did not induce anaphylactic reactions by a challenge test. Carboxymethylcellulose, an anionic water-soluble polymer derived from native cellulose, is considered to be unabsorbable from the human gut and has been widely and increasingly used in pharmaceutical preparations, cosmetics, and food. This article is the first report of anaphylaxis caused by carboxymethylcellulose-containing foods, whereas anaphylaxis to carboxymethylcellulose has been rarely associated with carboxymethylcellulose-containing pharmaceuticals. Although the exact mechanisms underlying the induction of late-onset anaphylaxis by carboxymethylcellulose remain unclear, a small minority of cellulose-digesting microbial flora in the human colon and contamination of food products with carboxymethylcellulose of low molecular weight might be involved. The induction of recurrent anaphylaxis by various products should be a clue that prompts physicians to suspect food additives as a cause for anaphylaxis.

Topics: Adolescent; Anaphylaxis; Carboxymethylcellulose Sodium; Female; Food Additives; Humans

Carboxymethylcellulose (CMC) is a derivative of cellulose found in many food products, pharmaceuticals and cosmetics. Allergy to CMC in parenteral corticosteroid preparations leading to anaphylaxis is rare, but has previously been reported. We report a case of a 52-year-old woman with prurigo nodularis of Hyde, who reacted with anaphylaxis after intradermal injection of Kenalog 40 mg/ml. Allergy testing showed a positive skin prick test for CMC and the patient was advised to avoid future parenteral exposure to CMC. This case highlights the need to examine excipients in severe cases of drug allergy.

Topics: Anaphylaxis; Carboxymethylcellulose Sodium; Drug Hypersensitivity; Female; Glucocorticoids; Humans; Injections, Intradermal; Middle Aged; Triamcinolone Acetonide

Topics: Aged; Anaphylaxis; Anti-Inflammatory Agents; Bursitis; Carboxymethylcellulose Sodium; Female; Hip Joint; Humans; Treatment Outcome; Triamcinolone Acetonide

Carboxymethylcellulose is a high-molecular-weight polysaccharide molecule used as a binding agent, for coating molecules and to increase the viscosity of formulations. It is present in a large number of pharmaceutical products but is also found in food and cosmetics.. We report two cases of patients who presented anaphylactic reactions immediately after localised corticosteroid injections; intra-articular for the first and intralesional for the second. Allergological testing for different corticosteroids and carboxymethylcellulose by means of prick-tests and intradermal testing indicated that the immediate hypersensitivity reaction was caused by the excipient, carboxymethylcellulose. The excellent safety of oral reintroduction of carboxymethylcellulose in a pharmaceutical preparation in these two patients confirmed that this large molecule is not absorbed through the digestive system.. The avoidance list of products containing carboxymethylcellulose could be greatly reduced and limited to only injectable pharmaceutical preparations containing carboxymethylcellulose and to oral contrast media containing large quantities of carboxymethylcellulose.

Topics: Adrenal Cortex Hormones; Anaphylaxis; Carboxymethylcellulose Sodium; Drug Hypersensitivity; Drug Tolerance; Female; Humans; Injections; Injections, Intra-Articular; Male; Middle Aged; Skin Diseases

We report the case of anaphylactic reaction to carboxymethylcellulose, a dispersant in corticosteroid preparation and contrast media. Skin prick testing in this patient revealed a positive response to carboxymethylcellulose at a dilution of 1/1000. Anaphylaxis secondary to carboxymethylcellulose has previously been reported. To avoid further problems, this patient was advised to alert medical staff for the presence of allergy to carboxymethylcellulose in the event of the need for further interventional procedures. Care should be taken when giving intradermal steroids to patients with a history of anaphylaxis after contrast media.

Topics: Adult; Allergens; Alopecia Areata; Anaphylaxis; Carboxymethylcellulose Sodium; Diagnosis, Differential; Emergency Treatment; Humans; Injections, Intralesional; Male; Preservatives, Pharmaceutical; Skin Tests

Carboxymethylcellulose (CMC) has been considered to be inert and is commonly used as an additive in medicines, foods and cosmetics. However, we experienced a patient who developed an anaphylactic reaction to CMC after an upper gastrointestinal examination using a barium meal containing CMC. Therefore, we examined the incidence of sensitization by CMC in healthy subjects, and categorized the high risk group prone to developing anaphylactic response to CMC.. An ELISA for detecting CMC-specific IgE antibody was developed using serum from the patient as a positive control. In the ten subjects exhibiting high anti-CMC IgE among 387 normal populations, histamine release from isolated leukocytes was performed.. Five of ten subjects with a high IgE titer showed a significant CMC-induced histamine release from leukocyte preparations in vitro as observed in the patient, and were classified as high risk group. There was a correlation between sensitization by CMC and that by Japanese cedar pollen. The incidence of sensitization in females was 2.4 fold higher than that in males.. The combination of ELISA and histamine release experiment made it possible to identify the high risk group for developing anaphylactic response. The administration of high dose CMC as a suspending agent in barium sulfate or injectable corticosteroids to this group should be avoided to prevent anaphylactic reactions in the clinic.

Topics: Adult; Anaphylaxis; Carboxymethylcellulose Sodium; Enzyme-Linked Immunosorbent Assay; Female; Histamine Release; Humans; Immunoglobulin E; Immunoglobulin G; Male; Middle Aged

Topics: Administration, Oral; Anaphylaxis; Anti-Inflammatory Agents; Carboxymethylcellulose Sodium; Drug Hypersensitivity; Drug Tolerance; Humans; Infusions, Parenteral; Injections, Intra-Articular; Male; Middle Aged; Skin Tests

Two patients developed anaphylaxis after injection of a corticosteroid preparation containing carboxymethylcellulose (E466). In both cases skin tests yielded positive immediate type reactions to pure carboxymethylcellulose. This hydrophilic derivative of cellulose has found wide application in the pharmaceutical, cosmetics and food industry. The diagnosis is based on skin testing as 9% of the normal population was found to have serum IgE antibodies to this compound. In case of anaphylaxis after injection of corticosteroids, carboxymethylcellulose in addition to corticosteroids should be included for skin testing.

Topics: Adrenal Cortex Hormones; Adult; Allergens; Anaphylaxis; Carboxymethylcellulose Sodium; Female; Humans; Injections; Male; Middle Aged; Skin Tests

Carboxymethylcellulose is a carbohydrate widely used as additive in tablets, cosmetics, some injectable hormone formulations, food (as E466) and as active principle in hydrocolloid dressings. Anaphylaxis to carboxymethylcellulose in parenteral corticosteroid preparations has previously been reported. Typically, skin tests were positive in such cases, occasionally specific IgE or histamine release have been demonstrated.. We report on 3 patients who suffered from anaphylactic symptoms after local injection of corticosteroid preparations. Intracutaneous skin tests with carboxymethylcellulose were positive; in 2, sulfidoleukotriene release could be measured in the cellular antigen stimulation test (CAST). Specific IgE could not be identified. Oral provocation tests with typical doses of carboxymethylcellulose as found in food and tablets were negative.. In patients with anaphylaxis to parenteral administration of carboxymethylcellulose, small amounts are tolerated by the oral route. Skin tests and CAST are useful diagnostic tools.

Topics: Adult; Aged; Anaphylaxis; Anti-Inflammatory Agents; Carboxymethylcellulose Sodium; Drug Delivery Systems; Drug Hypersensitivity; Female; Follow-Up Studies; Humans; Injections, Intra-Articular; Male; Middle Aged; Risk Assessment; Severity of Illness Index; Skin Tests; Steroids

Topics: Anaphylaxis; Anti-Inflammatory Agents; Carboxymethylcellulose Sodium; Drug Hypersensitivity; Humans; Injections, Intra-Articular; Male; Middle Aged; Triamcinolone

Topics: Anaphylaxis; Antibody Specificity; Barium Sulfate; Carboxymethylcellulose Sodium; Drug Hypersensitivity; Enzyme-Linked Immunosorbent Assay; Gastrointestinal Diseases; Humans; Immunoglobulin E; Incidence; Japan

Topics: Adult; Anaphylaxis; Carboxymethylcellulose Sodium; Female; Humans; Immunoglobulin E; Intradermal Tests; Male; Middle Aged; Triamcinolone Acetonide; Urticaria

Topics: Anaphylaxis; Barium Sulfate; Carboxymethylcellulose Sodium; Carrageenan; Humans

Topics: Anaphylaxis; Barium Sulfate; Carboxymethylcellulose Sodium; Digestive System; Female; Histamine Release; Humans; Leukocytes; Middle Aged; Radiography; Skin Tests

Two cases of anaphylactic shock are reported, occurring after intra-articular injections of corticosteroids, containing carboxymethylcellulose (CMC), benzylic acid, polysorbate 80, and merthiolate. Skin tests and leukocyte histamine release are positive to CMC and negative to the other substances including the corticosteroids: prednisolone acetate and cortivazol . No cross-reactivity with hydroxypropylcellulose was demonstrated. These tests lead to incriminate CMC in these patients. Anaphylaxis to CMC seems exceptional, though CMC is widely used in agro-alimentary and pharmaceutical industries, as well as hydroxypropylcellulose. In one case, the possibility of a sensitization by CMC as a food additive is discussed, insofar as the patient has a fixed eruption which has been suspected to be owed to intolerance to food additives.

Topics: Anaphylaxis; Carboxymethylcellulose Sodium; Delayed-Action Preparations; Drug Carriers; Drug Eruptions; Drug Hypersensitivity; Female; Glucocorticoids; Humans; Intradermal Tests; Male; Middle Aged; Prednisolone; Pregnatrienes

Cattle were more readily sensitised than guinea pigs to carboxymethylcellulose. Freund's complete adjuvant enhanced, but was not essential for, sensitisation. Schultz-Dale responses were obtained from pulmonary tissues of sensitised cattle but their sera failed to induce passive cutaneous anaphylaxis. Cattle could possibly be sensitised by carboxymethylcellulose contained in drug formulations.

Topics: Anaphylaxis; Animals; Antigens; Bordetella pertussis; Carboxymethylcellulose Sodium; Cattle; Cattle Diseases; Drug Hypersensitivity; Freund's Adjuvant; Guinea Pigs; Histamine Release; Injections, Intradermal; Injections, Intramuscular; Injections, Intraperitoneal; Injections, Intravenous; Methylcellulose; Muscle Contraction; Ovalbumin; Passive Cutaneous Anaphylaxis