Anaphylactic reaction intravenous

Iron salts occasionally cause gastrointestinal irritation, nausea, vomiting, constipation, diarrhea, headache, backache, and allergic reactions. The stools usually appear darker (black). Iron dextran is given by the parenteral route Hypersensitivity reactions, including fatal anaphylactic reactions, have been reported with the use of this form of iron. Additional adverse reactions include soreness, inflammation, and sterile abscesses at the intramuscular (IM) injection site Intravenous (IV) administration may result in phlebitis at the injection site When iron is administered via the IM route, a brownish discoloration of tlie skin may occur. Fhtients with rheumatoid arthritis may experience an acute exacerbation of joint pain, and swelling may occur when iron dextran is administered. 

HHMC can also be directly activated by agents injected intravenously for therapeutic (general anesthetics, protamine, etc.) or diagnostic purposes (radiocontrast media, etc.), which can cause non-IgE-mediated anaphylactic reactions in vitro [24,... 

Aprotinin. Aprotinin is a naturally occurring serine protease inhibitor, has found widespread applications either by the intravenous route or as a component of biological sealants, because of its ability to decrease blood loss, and, as a consequence, transfusion requirements. Anaphylactic reactions are mediated by IgG and IgE antibodies. The risk of anaphylactic reactions has been estimated between 0.5 and 5.8% when used intravenously during cardiac surgery, and at 5 for 100,000 applications when used as a biologic sealant [25]. Patients previously treated with this drug present an increased risk and any new administration should be avoided for at least 6 months following an initial exposure [25]. 

Heroin can be snorted, smoked, and given intravenously. Complications of heroin use include overdoses, anaphylactic reactions to impurities, nephrotic syndrome, septicemia, endocarditis, and acquired immunodeficiency. 

Indications for use of parenteral iron, e.g. as fer-rioxidesaccharate or iron dextran, are in patients on hemodialysis and patients with a disease which prevents absorption from the gastrointestinal tract, in patients who are on long term parenteral nutrition and sometimes in patients with inflammatory bowel disease. Parenteral iron does not raise the hemoglobin level significantly faster than oral therapy and carries a risk of severe adverse reactions. Reactions to intravenous iron include headache, malaise, fever, arthralgias, urticaria and in rare cases anaphylactic reactions, which may be fatal. 

It is usual to give a sedating antihistamine, for example chlorphenamine 10 mg by intramuscular or slow intravenous injection, because of the relatively short half-life of epinephrine (adrenaline), and because of the active role of histamine in anaphylaxis. In addition, the inflammatory reaction can be moderated by the administration of a corticosteroid, such as hydrocortisone 200 mg by intramuscular or slow intravenous injection. Corticosteroids may take several hours to act, but can be of some help in so-called biphasic anaphylactic reactions. 

Cyclosporin is usually given orally, although absorption is often unpredictable. The intravenous route is usually restricted to patients who cannot take the drug orally, because of the risk of anaphylactic reactions. Other uses of cyclosporin include psoriasis and severe, active rheumatoid arthritis when these do not respond to conventional treatment, and steroid-resistant nephrotic syndrome. 

A severe anaphylactic reaction occurred in one patient who was given an intravenous formulation of conjugated estrogens (SED-12, 1033) (70). Some formulations of conjugated estrogens contain foreign (equine) material. 

Searcy CJ, Kushner M, Nell P, Beckmann CR. Anaphylactic reaction to intravenous conjugated estrogens. Clin Pharm 1987 6(l) 74-6. 

Heroin can be snorted, smoked, and given intravenously. Complications of heroin use include overdoses, anaphylactic reactions to impurities, nephrotic syndrome, septicemia, endocarditis, and acqnired immunodeficiency. Oxycodone, a controUed-release dosage form, is sometimes crushed by abusers to get the full 12-hour effect almost immediately. Snorting or injecting the crushed tablet can lead to overdose and death. 

Anaphylactic reactions result from the interaction of antigens with specific IgE antibodies, which have been formed by previous exposure to the antigen. Anaphylactoid reactions are clinically indistinguishable from anaphylaxis but do not result from prior exposure to a triggering agent and do not involve IgE. Intravenous anaesthetics and muscle relaxants can cause anaphylactic or anaphylactoid reactions and, rarely, they are fatal. Muscle relaxants are responsible for 70% of anaphylactic reactions during anaesthesia and suxamethonium accormts for almost half of these. 

Shaw AD, Boscoe MJ. Anaphylactic reaction following intravenous adenosine. Anaesthesia 1999 54(6) 608. 

An acute, life-threatening, anaphylactic reaction has been described in a child who received his first intravenous injection of ceftriaxone (168). 

Anaphylactic reactions have very rarely occurred after intravenous cyclophosphamide (SED-8, 1126) (SEDA-17, 522) (36), and positive skin tests to the parent drug and/or 4-hydroxycyclophosphamide were found in several well-documented case reports (SEDA-19, 347). Although other mechanisms could be considered, a possible IgE antibody-mediated reaction was substantiated by the positivity of immediate skin tests to cyclophosphamide metabolites in five patients, and the recurrence of symptoms following intravenous or oral rechallenge in several of them (37). 

An anaphylactic reaction with shock after a 10th dose of fluorouracil 900 mg intravenously was reported in a 60-year-old man with colorectal adenocarcinoma (124). Two minutes after his 10th dose of fluorouracil, he became cyanotic and collapsed, with a rapid thready pulse of 120. His blood pressure was 30/0 mmHg. Adrenaline 1 1000, 1 ml, was given, with immediate and prompt signs of recovery. Within 25 minutes, his blood pressure, pulse, and skin color had returned to normal. 

Some reports suggest that anaphylaxis due to intravenous immunoglobulin infusion occurs most often in patients with primary hypogammaglobulinemia (115,116). However, anaphylactic reactions have been seen in two atopic patients with idiopathic thrombocytopenic purpura, and the authors warned that children with atopic disease should not receive intravenous immunoglobulin (117). 

Most parenteral iron is administered intramuscularly, but intravenous injections have enjoyed a wave of popularity for no very good medical reason it seems particularly likely to precipitate acute allergic or anaphylactic reactions in sensitive individuals, sometimes involving cardiac dysrhythmias, hypotension, circulatory collapse, and pulmonary edema. 

Large doses of intravenous iron dextran and iron saccha-rate have been compared in a retrospective study of 379 patients who had attended peritoneal dialysis clinics in the past 5 years (12). Of these, 62 were selected to receive intravenous iron based on ferrokinetic markers of iron deficiency, non-adherence to oral iron, ineffectiveness of oral iron, or increased erythropoietin requirements. Intravenous iron was given as two injections of 500 mg each 1 week apart in 61 patients, 33 of whom received iron dextran, 23 iron saccharate, and five both iron dextran and iron saccha-rate. One patient developed anaphylaxis to a test dose of iron dextran and was excluded from further therapy. Blood samples were collected before and 3 and 6 months after iron infusions. Five of the 34 patients who received iron dextran developed minor adverse effects and one had an anaphylactic reaction to the test dose. Of the 23 patients who received iron saccharate, one had an anaphylactic reaction and two had transient chest pain, which subsided without therapy. There were more adverse effects with iron dextran (7.4% of injections) compared with iron saccharate (4.3% of injections), but this difference was not statistically significant. The number of episodes of peritonitis also increased during the 6 months after intravenous iron infusion, especially with iron dextran, compared with the number of episodes during the 6 months before iron infusions, although the difference was not statistically significant. 

Parenteral naftidrofuryl was withdrawn from the market following reports of severe adverse effects with intravenous or intra-arterial bolus injections, including intracardiac conduction defects, epileptic seizures, severe anaphylactic reactions, and acute renal insufficiency secondary to deposition of oxalate crystals in the tubules (SED-12, 473) (SEDA-17, 244). 

Skin rashes due to podophyllotoxin derivatives may be hypersensitivity reactions and can be related to the drug itself or more commonly to the vehicles used. Dose-related, non-IgE-mediated hypersensitivity has been reported in 16 children receiving teniposide (118). Other published reports of hypersensitivity or anaphylactoid reactions to teniposide include degranulation of basophils (119,120), and eight anaphylactic reactions in children, all associated with the use of intravenous teniposide 150 mg/ m (121). 

An anaphylactic reaction occurred in a 77-year-old woman 5 minutes after the start of a vancomycin infusion, when she had received only 40 mg (88). She became unconscious and had a severe cardiovascular collapse, from which she was resuscitated with intravenous ephedrine and adrenaline. 

The recommendation that prolongation of the international normalized ratio (INR) to over 6.0 should be corrected vvith parenteral phytomenadione (24,25) is not accompanied by the caveat that the intravenous route entails the risk of life-threatening, non-IgE-mediated anaphylactic reactions and even death, due to the use of polyethoxylated castor oil (Cremophor EL) as a solvent (26). A severe reaction to intravenous phytomenadione has been reported (27). 

Chapuis B, Helg C, Jeannet M, et al. Anaphylactic reaction to intravenous cyclosporine. N Engl ] Med 1985 312 1259. 

The incidence of adverse reactions to radiophannaceuli-eals is estimated to be le.ss than 0.(M)6%. Most reactions are allergic and occur within minutes after intravenous injection. In the ease of radiolabeled murine antibodies, an anaphylactic reaction may occur, although serious reuelions of this type have not been reported. 

Severe anaphylactic reactions following intravenous administration of diazepam have been reported. Meprobamate causes toxicity similar to that of a barbiturate overdosage. Death may result from respiratory failure or hypotension. Limited information is available about the acute toxicity of Buspirone. Effects are merely extensions of pharmacological effects. Nausea, vomiting, dizziness, drowsiness, miosis, and gastric distention may be seen. 

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