Anaphylactoid immediate reactions

Growth factor potential The possibility that epoetin alfa can act as a growth factor for any tumor type, particularly myeloid malignancies, cannot be excluded. Hypersensitivity reactions Skin rashes and urticaria are rare, mild, and transient. If an anaphylactoid reaction occurs, immediately discontinue the drug and initiate appropriate therapy. Refer to Management of Acute Hypersensitivity Reactions. Fertility Impairment In female rats treated IV with epoetin alfa, there was a trend for slightly increased fetal wastage at doses of 100 and 500 units/kg. 

Type I hypersensitivity reactions (immediate hypersensitivity or anaphylaxis) are immunologic responses to a foreign antigen to which a patient has been previously sensitized. Anaphylactoid reactions are not immunoogically mediated however, symptoms and treatment are similar. 

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. 

Serious and occasionally fatal anaphylactoid reactions have been reported in patients on penicillin therapy Serious anaphylactoid reactions require immediate emergency treatment with epinephrine Pseudomembranous colitis has been reported... 

A severe anaphylactoid reaction occurred immediately after the instillation of a 10% solution of povidone-iodine into a hydatid cyst cavity during surgery. Severe bronchospasm developed immediately and was followed by a coagulopathy and subsequent liver and renal insufficiency (33). 

Anaphylactoid reactions to local injectable anesthetics are extremely rare. Although these reactions are usually immediate, they may be delayed as long as 15 to 30 minutes. Anaphylactoid reactions are characterized by a sudden circulatory collapse after drug administration. Urticaria, respiratory distress, cyanosis, and hypotension usually occur. Treatment directed at correcting the circulatory collapse and respiratory failure must be initiated promptly, because even a short delay can be fatal. 

It is possible for a severe dextran-induced anaphylactic/ anaphylactoid reaction to develop despite prophylaxis with monovalent hapten dextran (30). This has been reported in a 60-year-old patient with multiple trauma, who received a dextran infusion for prophylaxis of thrombosis due to severe thrombocjdosis in the late postoperative period. The causal relation to dextran was considered likely, although no serum sample was taken before the reaction, due to the close time relation to the infusion of dextran 60. In addition, there were high titers of dex-tran-reactive antibodies in the blood drawn immediately after the reaction occurred. 

An anaphylactoid reaction in a pregnant woman occurred immediately after the administration of dextran 40 solution (32). The baby was delivered rapidly by cesarean section after the event, and was apparently dead at birth but successfully resuscitated. The case has prompted Barbier and colleagues to report on the safety in general of dextran administered during pregnancy (32). They found information on 32 moderate anaphylactoid reactions associated with severe fetal distress and they advised avoiding preventive fluid preload with dextran in pregnancy. 

Anaphylactic shock associated with cinoxacin was reported in three patients by the Netherlands Center for Monitoring of Adverse Reactions to Drugs (97). Another 17 cases were reported to the WHO Collaborating Center for International Drug Monitoring. In some cases the reaction was observed immediately after the first dose of a repeat cycle of treatment. Anaphylactoid reactions to ciprofloxacin have been reported in patients with cystic fibrosis (98-100). 

The most serious hypersensitivity reactions produced by the penicillins are angioedema and anaphylaxis. Acute anaphylactic or anaphylactoid reactions to the penicillins constitute the most important immediate danger connected with their use. Among all drugs, the penicillins are most often responsible for this type of untoward effect. Anaphylactoid reactions to penicillins may occur at any age their incidence is thought to be 0.004-0.04%. About 0.001% of patients treated with these agents die from anaphylaxis. Anaphylaxis most often has followed parenteral use but also has been observed after oral or intradermal administration. The most dramatic reaction is sudden hypotension and death. In other instances, bronchoconstriction with severe asthma abdominal pain, nausea, and vomiting extreme weakness or diarrhea and purpuric skin eruptions have characterized the anaphylactic episodes. 

The leucocyte histamine release test (referred to in greater detail in Chaps. 1-7) is one of the in vitro correlates of immediate allergy which may find useful application in investigating reactions to local anaesthetics. It is of some value in detecting acute reactions, whether they are truly anaphylactic or due to direct (non-immune) histamine release (anaphylactoid). It is also more accurate (quantitative), more reliable and more predictive than skin tests, and above all it is free from risk. 

Mechlorethamine is a nitrogen mustard which is used in psoriasis. Taylor and Halprin (1972) sensitized 34 of 57 patients treated attempts to induce immunologic tolerance were unsuccessful. A woman with mycosis fungoides developed an urticarial and anaphylactoid reaction inunediately after a total body surface application of nitrogen mustard (Daughters et al. 1973). She received at least 100 applications prior to this reaction, which waned after an antihistamine injection. Immediate sensitivity to nitrogen mustard may not be rare (Grunnet 1976). 

For many years, two terms, anaphylaxis and anaphylactoid, have been used to describe relatively rare reactions that have features commonly associated with severe immediate, often life-threatening, allergic reactions. These two terms are distinguished by the underlying mechanisms of the reactions. The term anaphylaxis is used by many for an immune IgE antibody-mediated, systemic immediate type I hypersensitivity reaction, often occurring within seconds or minutes. 

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