orabase and Drug-Hypersensitivity

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

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

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: Adult; Angioedema; Carboxymethylcellulose Sodium; Conjunctiva; Drug Hypersensitivity; Face; Humans; Immunoblotting; Male; Methylprednisolone; Ophthalmic Solutions; Skin Tests

Topics: Aged, 80 and over; Carboxymethylcellulose Sodium; Drug Eruptions; Drug Hypersensitivity; Drugs, Generic; Excipients; Female; Heart Failure; Humans

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

Topics: Administration, Oral; Anaphylaxis; Anti-Inflammatory Agents; Carboxymethylcellulose Sodium; Drug Hypersensitivity; Drug Tolerance; Humans; Infusions, Parenteral; Injections, Intra-Articular; 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: Aged; Carboxymethylcellulose Sodium; Dermatitis, Allergic Contact; Drug Combinations; Drug Eruptions; Drug Hypersensitivity; Gelatin; Humans; Male; Pectins; Polyenes

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

Topics: Aged; Anesthetics, Local; Carboxymethylcellulose Sodium; Drug Hypersensitivity; Female; Gels; Humans; Lidocaine; Pharmaceutic Aids

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