Anaphylactic and Anaphylactoid Reactions

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

Anaphylactoid and anaphylactic reactions to OADs same clinical picture same inunediate management... 

Anaphylactoid and anaphylactic reactions are distinguished by the underlying mechaitism Anaphylactic reactions are immune (IgE antibody)-mediated anaphylactoid reactions are not... 

At normal doses, codeine, even more so than morphine and despite its capacity to release histamine in the skin (but perhaps also reflecting the differences in parenteral administration), has rarely been implicated in anaphylactoid or anaphylactic reactions. However, an unusual case of fever with urticaria, generalized pruritus, and... 

Anaphylactoid An anaphylactic-like reaction, similar in signs and symptoms, but not mediated by IgE. A drug causing this reaction produces direct release of inflammatory mediators by a pharmacologic effect. 

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. 

Anaphylactic or anaphylactoid reactions may occur following administration of any dose or course of muromonab-CD3. Serious and occasionally life-threatening systemic, cardiovascular, and CNS reactions have been reported. These have included the following Pulmonary edema, especially in patients with volume overload shock cardiovascular collapse cardiac or respiratory arrest seizures coma. Hence, a patient being treated with muromonab-CD3 must be managed in a facility equipped and staffed for cardiopulmonary resuscitation. 

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). 

Mertes PM, Laxenaire MC, Alla F Groupe d Etudes des Reactions Anaphylactoides Peranesthesiques. Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999-2000. Anesthesiology 2003 99(3) 536-45. 

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. 

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. ... 

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... 

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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