Allergic drug reactions anaphylactoid

Optic neuritis (a decrease in visual acuity and changes in color perception), which appears to be related to the dose given and die duration of treatment, has occurred in some patients receiving ethambutol. Usually, tiiis adverse reaction disappears when the drug is discontinued. Other adverse reactions are dermatitis, pruritus, anaphylactoid reactions (unusual or exaggerated allergic reactions), joint pain, anorexia, nausea, and vomiting. 

Most anaphylactoid reactions are due to a direct or chemical release of histamine, and other mediators, from mast cells and basophils. Immune-mediated hypersensitivity reactions have been classified as types I-IV. Type I, involving IgE or IgG antibodies, is the main mechanism involved in most anaphylactic or immediate hypersensitivity reactions to anaesthetic drugs. Type II, also known as antibody-dependent hypersensitivity or cytotoxic reactions are, for example, responsible for ABO-incompatible blood transfusion reactions. Type III, immune complex reactions, include classic serum sickness. Type IV, cellular responses mediated by sensitised lymphocytes, may account for as much as 80% of allergic reactions to local anaesthetic. 

Etomidate is the indnction agent of choice in atopic patients, in whom etomidate, fentanyl, and vecuronium comprise the safest combination of drugs for general anesthesia. However, non-allergic anaphylactic (anaphylactoid) reactions have been observed, even with this combination (23,24), and it can even be life-threatening one patient also had a myocardial infarction (24). 

The manufacturers received 1100 reports of allergic reactions in the first 2 years after launch. Fatal anaphylactic and anaphylactoid reactions have been reported 10% of all reports on anaphylactic reactions in the USA named zomepirac, making it second only to the much older drug tolmetin. Hypersensitivity reactions are characterized by hypotension, bronchospasm, and serious respiratory distress, with or without oropharyngeal edema. Type-Ill allergic reactions have also been described. 

Howrie DL, Ptachcinski RJ, Griffith BP, et al. Anaphylactoid reactions associated with parenteral cyclosporine use possible role of cremophor EL. Drug Intell Clin Pharm 1985 19 425-427. van Hooff JP, Bessems P, Beuman GH, Leunissen KML. Absence of allergic reaction to cyclosporin capsules in patient allergic to standard oral and intravenous solution of cyclosporin [letter]. Lancet 1987 ii 1456. 

Allergic reactions (2000) Reinhart Dl, Drug Saf 22, 487 Anaphylactoid reactions/Anaphylaxis (< 1%) Angioedema... 

Allergic reactions to aU three agents have been described. For etanercept, injection site reactions can occur in up to 20% of patients (287). Some patients develop recall reactions in areas of prior injections (288). More severe reactions, including anaphylactoid reactions, have been reported with infliximab. Up to 20% of patients with infliximab develop infusion reactions. The rate is lower for those patients receiving a concomitant cytotoxic drug such as MTX (289). Infliximab is a chimeric monoclonal antibody. Patients with infusion reactions to infliximab have been successfully treated with the humanized monoclonal antibody adalimumab (278,290). 

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