toxiferine and Anaphylaxis

A 67-year-old woman suffered cardiovascular collapse during induction of anaesthesia. This was later shown to be anaphylactic in origin; the causative agent was alcuronium. In vitro testing showed a highly specific sensitivity to alcuronium with minimal cross-reactivity. Future anaesthesia with decreased risk was thereby assured. The clinical nature of this reaction and a review of the literature implicate the cardiovascular system as the principal target in this type of reaction to alcuronium and suggest that the heart is directly involved.

Topics: Aged; Alcuronium; Anaphylaxis; Drug Hypersensitivity; Female; Histamine Release; Humans; In Vitro Techniques; Leukocytes; Toxiferine

Reports of allergic complications related to Alloferin are very infrequent. We report a case of anaphylactoid reaction to this drug. The diagnosis was confirmed by intradermal testing.

Topics: Alcuronium; Anaphylaxis; Humans; Male; Middle Aged; Toxiferine

Although anaphylactoid reactions to muscle-relaxant drugs are now well recognised, there has been no general agreement on the mechanism(s) underlying the responses. By covalently coupling alcuronium and tubocurarine to a solid phase carrier and using the resultant complexes in radioimmunoassay experiments with patients' sera and 125I-anti-human IgE, we have found high levels of drug-specific IgE antibodies in the sera of some subjects who reacted to these muscle relaxants. These results provide important supporting evidence that, in some patients at least, life-threatening anaphylactoid reactions to muscle-relaxant drugs are mediated by drug-specific IgE antibodies.

Topics: Adult; Aged; Alcuronium; Anaphylaxis; Female; Humans; Immunoglobulin E; Male; Middle Aged; Muscle Relaxants, Central; Toxiferine; Tubocurarine

Topics: Alcuronium; Anaphylaxis; Female; Humans; Intradermal Tests; Toxiferine

IgE antibodies that bind the muscle relaxant alcuronium were found in sera from six patients who experienced anaphylactic-like reactions following administration of the drug during induction of anaesthesia. Drug-specific antibodies were detected by radioimmunoassay employing a covalently coupled alcuronium-Sepharose complex and 125I-labelled anti-human IgE. Quantitative inhibition studies undertaken with the sera revealed specificity differences between IgE antibodies from different patients. One serum reacted with alcuronium but not with five other muscle relaxants, decamethonium, gallamine, pancuronium, succinylcholine and tubocurarine. IgE antibodies in the other sera cross-reacted with the muscle relaxants, other quaternary ammonium compounds and some pharmacologically unrelated drugs including promethazine, morphine, neostigmine and pentolineum. The inhibition experiments revealed that the alcuronium-IgE reaction could be prevented or diminished by structures containing a substituted ammonium ion. As these ions occur widely in man's environment in drugs, cosmetics, disinfectants, foods and industrial materials, it seems possible that sensitization of patients may occur without previous exposure to muscle relaxants.

Topics: Adult; Alcuronium; Anaphylaxis; Antibody Specificity; Antigen-Antibody Reactions; Cross Reactions; Humans; Immunoglobulin E; Muscle Relaxants, Central; Neuromuscular Blocking Agents; Radioimmunoassay; Toxiferine

Topics: Alcuronium; Anaphylaxis; Anesthesia, General; Female; Humans; Leiomyoma; Middle Aged; Toxiferine; Uterine Neoplasms

Topics: Adult; Alcuronium; Anaphylaxis; Anesthesia, General; Female; Histamine Release; Humans; In Vitro Techniques; Skin Tests; Toxiferine

A patient who suffered an anaphylactic shock during general anaesthesia showed positive reactions in a skin test with fentanyl (i.e. in Thalamonal) and Alloferin. As we did not find similar case reports in literature we present this rare case of anaphylactic shock during general anaesthesia evidently based on allergic mechanisms induced by fentanyl and Alloferin.

Topics: Adult; Alcuronium; Anaphylaxis; Anesthesia, General; Antigen-Antibody Reactions; Fentanyl; Histamine Release; Humans; Male; Skin Tests; Toxiferine

Five cases of severe anaphylactic reactions to alcuronium are described. Investigation suggested that these are probably true anaphylaxis to the drug. The cases illustrate the value of intradermal testing in detecting the drug involved and the necessity of using colloidal solutions and adrenaline in the management of hypotension due to anaphylaxis.

Topics: Adolescent; Adult; Aged; Alcuronium; Anaphylaxis; Epinephrine; Female; Humans; Male; Middle Aged; Skin Tests; Toxiferine

Topics: Ampicillin; Anaphylaxis; Cholangiography; Cholecystectomy; Cholelithiasis; Drug Hypersensitivity; Female; Humans; Injections, Intravenous; Iodipamide; Middle Aged; Skin Tests; Toxiferine