Anaphylactic/anaphylactoid reactions

Hedin H, Richter W, Messmer K, Renck H, Ljungstrom KG, Laubenthal H (1981 b) Incidence, pathomechanism and prevention of dextran induced anaphylactoid/anaphylactic reactions in man. Dev Biol Stand 48 179-189 Hehre EJ, Neill JM (1946) Formation of serologically reactive dextrans by streptococci from subacute bacterial endocarditis. J Exp Med 83 147-162 Hehre EJ, Sugg JY (1950) Serological reactivity of dextran plasma substitute. Fed Proc 9 383... 

Table 8.7 Summary of some case studies of anaphylactoid/anaphylactic reactions to opioid analgesic drugs and diagnostic conclusions... 

Prevention of Anaphylactoid/ Anaphylactic Reactions to Iodinated Contrast Media... 

Cardiovascular and respiratory mechanisms in anaphylactic and anaphylactoid shock reactions. Klin... 

The parenteral use of complexes of iron and carbohydrates has resulted in anaphylactic-type reactions. Deaths associated with such administration have been reported therefore, use iron dextran injection only in those patients in whom the indications have been clearly established and laboratory investigations confirm an iron-deficient state not amenable to oral iron therapy. Because fatal anaphylactic reactions have been reported after administration of iron dextran injection, administer the drug only when resuscitation techniques and treatment of anaphylactic and anaphylactoid shock are readily available. 

These are adverse reactions resembling the effects of histamine liberation Chistaminoid ) and unrelated to the mode of action of the drug itself. Histamine release appears to be the main factor involved in all types of hypersensitivity reactions and its release explains most of the manifestations. The term anaphylactoid may equally be used to describe these reactions, meaning simply that they resemble anaphylactic reactions, while the term anaphylactic is used specifically for immune-mediated phenomena involving previous sensitisation of the patient. It is often difficult to determine the true nature and cause of the reaction. 

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. 

Among the anaphylactic reactions to NSAIDs that result in different types of reaction (urticaria, angioedema, asthma, or hypotension), there have been very few reports of anaphylactic shock. However, anaphylaxis has been described in patients taking celecoxib (135,136) or rofecoxib (137). Rofecoxib caused anaphylaxis in a patient who had had a similar reaction to diclofenac, suggesting that COX-2 inhibitors may be not safe in all individuals who have adverse reactions to non-selective COX inhibitors. It also suggests that different mechanisms may be involved in patients with asthma and in those with anaphylactoid reactions to NSAIDs. 

Acute allergic reactions were reported in 48 patients, and included anaphylactic or anaphylactoid reactions and angioedema without shock. Two anaphylactic reactions, one fatal, to parenteral diclofenac have been reported (SEDA-18, 104). Hepatorenal damage (SEDA-15, 100), thrombocytopenia, and hemoljdic anemia mediated by an immune mechanism have been reported (SEDA-16,110). 

Rare anaphylactic reactions with antimuromonab IgE antibodies have been reported (SED-14, 1309). Anaphylactoid reactions to muromonab can also occur (38). 

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). 

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. 

Anaphylactic reactions (IgE-medlated) Anaphylactoid reactions (not IgE-medlated)... 

Lang DM Anaphylactoid and anaphylactic reactions Hazards of beta-blockers Drug Strfety (1995)12,299-304... 

When anaphylactic reactions do occur in patients taking beta blockers, it may be preferable to use a beta-agonist bronchodilator such as isoprena-line rather than adrenaline (epinephrine). Glucagon, which has inotropic and chronotropic actions that are only minimally antagonised by beta blockers, may also be effective in reversing anaphylactoid shock in patients taking beta blockers. ... 

Lorenz W, Doenicke A, Reimann HJ, Schmal A, Schwarz B, Dorman P (1978) Anaphylactoid reactions and histamine release by plasma substitutes a randomized controlled trial in human subjects and in dogs. Agents Actions 8 397-399 Liiben G, Quast U, Geiger H (1981) Prekallikrein activator levels and side effects with human albumin preparations. Dev Biol Stand 48 123-127 Lund N (1973) Anaphylactic reactions induced by infusion of haemaccel. Br J Anaesth 45 929... 

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