toxiferine and Drug-Hypersensitivity

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

A radio-immunoassay (RIA) was used to screen for specific IgE to myorelaxants. Alcuronium was coupled to epoxy-activated Sepharose. Sixteen patients with anaphylaxis to alcuronium (n = 2), gallamine (n = 2) or suxamethonium (n = 12) were studied. The diagnosis was established by intradermal tests (ID), passive cutaneous anaphylaxis tests and human basophil degranulation tests. The amount of non specific label retained by Sepharose-ethanolamine (with sera of patients) and Sepharose-alcuronium (with sera of 11 control subjects) was estimated. The RIA was positive 10/16 (8/14 patients having reacted to a muscle relaxant other than alcuronium). The RIA seemed to be useful in the diagnosis of anaphylaxis to muscle relaxants. Drug-reactive antibodies were specific of the quaternary ammonium radical, which was the common allergenic determinant of all molecules of muscle relaxants. This test accounted for in vitro cross-reactivity, but had no predictive value for the clinical risk of crossed-anaphylaxis. This risk was best assessed by ID; it was positive in three cases. Although it was not possible to compare ID and RIA, the interpretation of which was different, both tests should be recommended for the detection of sensitivity to muscle relaxants.

Topics: Adolescent; Adult; Alcuronium; Drug Hypersensitivity; Female; Humans; Immunoglobulin E; Male; Middle Aged; Radioimmunoassay; Toxiferine

Allergic reactions to the intravenous drugs used in anaesthesia pose a major problem for the anaesthetist, since they represent an unpredictable and occasionally life-threatening event. Reports of 2 such cases are presented, and the incidence, assessment and prophylaxis of such reactions are discussed.

Topics: Alcuronium; Anesthesia, Intravenous; Anesthetics; Child; Drug Hypersensitivity; Female; Humans; Male; Middle Aged; Pregnanediones; Toxiferine

Topics: Alcuronium; Drug Hypersensitivity; Humans; Muscle Relaxants, Central; Toxiferine

Topics: Alcuronium; Australia; Cross Reactions; Drug Hypersensitivity; Humans; Immunoglobulin E; Intradermal Tests; Neuromuscular Blocking Agents; Neuromuscular Depolarizing Agents; Toxiferine

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