Anaphylactic shock procaine

Hoigne R, Schoch K. Anaphylaktischer Schock und akute nichtallergische Reaktionen nach Procain-Penicillin. [Anaphylactic shock and acute nonallergic reactions following procaine-penicillin.] Schweiz Med Wochenschr 1959 89 1350-6. 

Hypersensitivity to local anesthetics appears to be related to both chemical structure and the method of administration. Allergic reactions occur most frequently with csler-ba.sed local anesthetic agents (benzoic acid derivatives). Adverse effects include allergic dermatitis, asthmatic attack, or. in extreme cases, death due to anaphylactic shock. Individuals suffering a hypersensitive reaction from one local anesthetic agent are often sensitive to compounds with a. similar structure. For example, patients semsilive to procaine arc often also sensitive to amethocaine... 

Procaine, on the other hand, is an ester-type local anesthetic when it is injected into the organism, it is transformed into N,N-diethylaminoethanol and para-amino-benzoic acid (PABA) when the ester link that binds these two components of procaine is broken. PABA is a well-known allergen. Methyl para-hydroxybenzoate, whose structure is similar to that of PABA, is also called PAB or methylparaben. It is a preservative that binds, like a hapten, to the immunoglobulin E (IgE) on the surface of mast cells and basophils and maybe the cause of the few cases of anaphylactic shock that have been described. Other patients may be allergic to metabisulfite conservative, found in preparations containing adrenaline (epinephrine). 

Two cases of anaphylactic shock after retrobulbar injection with procaine, one of them fatal, have recently been described (24 ). Two other cases were confirmed by positive skin tests (25 ). 

Struzak-Wysokihska, M. (1976) The problem of anaphylactic shock following procaine hypersensitivity (Polish). Czas. stomat.. 29, 415. 

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