pituitrin and Drug-Hypersensitivity

Immediate hypersensitivity reactions are an important cause for mortality and morbidity in anesthesia. The present review considers reports covering epidemiology, diagnosis, and treatment of these reactions.. Immediate hypersensitivity reactions are largely under-reported, adult women being at significantly higher risk than men. The role of sex hormones associated with increased risk in adult women has been demonstrated. Neuromuscular blocking agents (NMBAs) remain the most frequently incriminated drugs. Reactions involving antibiotics, dyes, or nonsteroidal anti-inflammatory agents are reported with increasing frequency, in parallel with changing trends in clinical practice. A recent hypothesis concerning a link between pholcodine exposure and allergic reactions to NMBAs is under investigation. Detailed guidelines concerning skin testing have been provided. The use of several inotropes or vasopressor such as vasopressin is proposed in case of reactions refractory to epinephrine and volume expansion. The use of cyclodextrin to mitigate severe allergic reactions to rocuronium, by specific drug encapsulation, has been proposed.. Hypersensitivity reactions remain a major cause of concern in the perioperative setting. Although largely under-reported, their incidence is higher than previously reported. NMBAs remain the most frequently incriminated drug, followed by latex and antibiotics. The number of reactions involving new allergens like vital dyes or nonsteroidal anti-inflammatory drugs is rapidly increasing. The mechanism of sensitization to NMBAs could be influenced by as yet unidentified environmental factors. The possible role of pholcodine is under investigation. Several guidelines concerning the diagnosis and management of immediate hypersensitivity reactions in anesthesia are now available.

Topics: Adult; Analgesics; Anesthesia; Anesthetics; Codeine; Drug Hypersensitivity; Epinephrine; Female; Humans; Male; Morpholines; Neuromuscular Blocking Agents; Risk Factors; Sex Factors; Skin Tests; Vasoconstrictor Agents; Vasopressins

Topics: Aging; Angiotensin II; Animals; Atropine; Bartter Syndrome; Bone and Bones; Carbohydrate Metabolism; Cardiovascular Diseases; Drug Hypersensitivity; Gastric Mucosa; Gastrointestinal Diseases; Heart; Hematologic Diseases; Humans; Kidney Failure, Chronic; Parathyroid Diseases; Parathyroid Hormone; Pharmaceutical Preparations; Rabbits; Rats; Thyroid Diseases; Uremia; Vasopressins; Vitamin D

The case of a 40-year-old woman with severe edema of the face and neck after the injection of a local dental anesthetic is presented. The reaction is attributed to the presence of sodium metabisulfite, and antioxidant, in the local anesthetic. Both the anesthetic and the sodium metabisulfite gave a delayed positive patch-test response.

Topics: Adult; Anesthesia, Dental; Anesthetics, Local; Drug Combinations; Drug Hypersensitivity; Female; Humans; Lidocaine; Norepinephrine; Sulfites; Vasopressins

Topics: Administration, Intranasal; Adult; Arginine Vasopressin; Asthma; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Hypersensitivity; Humans; Male; Pulmonary Fibrosis; Vasopressins

Topics: Antibody Formation; Antibody Specificity; Diabetes Insipidus; Drug Hypersensitivity; Electrocardiography; Humans; Hypergammaglobulinemia; Hypopituitarism; Iatrogenic Disease; Immunodiffusion; Immunoelectrophoresis; Immunoglobulin G; Male; Middle Aged; Pituitary Hormones, Posterior; Powders; Vasopressins

Topics: Asthma; Drug Hypersensitivity; Female; Humans; Respiratory Hypersensitivity; Rhinitis; Vasopressins

Topics: Aerosols; Blood Pressure; Breast; Costs and Cost Analysis; Diabetes Insipidus; Diuresis; Drug Combinations; Drug Hypersensitivity; Female; Humans; Intestines; Nose; Oxytocin; Tannins; Uterus; Vasopressins; Water Intoxication

Topics: Animals; Back; Catecholamines; Denervation; Drug Hypersensitivity; Felypressin; Female; Ganglia, Autonomic; Norepinephrine; Phentolamine; Radioisotopes; Rats; Regional Blood Flow; Scalp; Skin; Sympathectomy; Synapses; Vasoconstrictor Agents; Vasopressins; Xenon

Topics: Angiotensin II; Animals; Arrhythmias, Cardiac; Coronary Vessels; Dogs; Drug Hypersensitivity; Epinephrine; Female; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Male; Myocardial Infarction; Norepinephrine; Vasopressins

Topics: Allergens; Anaphylaxis; Animals; Antigen-Antibody Reactions; Child, Preschool; Diabetes Insipidus; Drug Hypersensitivity; Erythrocytes; Hemagglutination Tests; Histiocytosis, Langerhans-Cell; Humans; Immune Sera; Immunization, Passive; Immunochemistry; Immunodiffusion; Immunoglobulin E; Lysine; Male; Oxytocin; Phenylalanine; Sheep; Skin Tests; Vasopressins

Topics: Adult; Diabetes Insipidus; Drug Hypersensitivity; Female; Humans; Male; Vasopressins

Topics: Adult; Antigen-Antibody Reactions; Diabetes Complications; Diabetes Insipidus; Drug Hypersensitivity; Female; Fluorescent Antibody Technique; Humans; Immunoelectrophoresis; Pulmonary Fibrosis; Radiography; Respiratory Function Tests; Respiratory Therapy; Skin Tests; Vasopressins

Topics: Adolescent; Adult; Drug Hypersensitivity; Edema; Estrogens; Female; Follicle Stimulating Hormone; Growth Hormone; Hormones; Humans; Middle Aged; Progesterone; Progestins; Urticaria; Vasopressins

Topics: Animals; Antibodies; Antigen-Antibody Reactions; Cattle; Dialysis; Drug Hypersensitivity; Humans; In Vitro Techniques; Iodine Isotopes; Poultry; Rabbits; Swine; Vasopressins

Topics: Adrenal Cortex Hormones; Allergens; Anaphylaxis; Anesthesia; Anesthetics; Drug Hypersensitivity; Drug Therapy; Epinephrine; Geriatrics; Humans; Hypersensitivity; Isoproterenol; Oxygen Inhalation Therapy; Skin Tests; Theophylline; Toxicology; Vasopressins

Topics: Diabetes Insipidus; Drug Hypersensitivity; Humans; Vasopressins