Cutaneous flushing

Hj-antagonists alone, such as cimetidine or ranitidine, have a modest effect on cutaneous flush reaction and maybe also on the heart [14, 52]. However, when applied they should be given together with Hj-antagonists. There are some studies showing a beneficial effect of combined H - and Hj-antagonist treatment or pretreatment in anaphylaxis [46, 53]. 

The major adverse effect of niacin treatment is intense cutaneous flushing (vasodilation), which manifests as an uncomfortable burning sensation and itchiness of the face and upper body, thereby limiting patient compliance to therapy [13]. Moreover, a short half-life, dyspepsia, hyperuricemia, and modest hyperglycemia were also reported [14-16]. 

Nicotinic acid in large doses used to treat hyperlipoproteinemia causes a cutaneous flush. The vasodilator) effect is due to... 

Compliance with nicotinic acid therapy can be poor because the drug can produce an intense cutaneous flush. This can be reduced by beginning the drug in... 

Nicotinic acid (niacin) Yes Reduces LDL Reduces VLDL Raises HDL IV Ik with fibrates severe IV with fibrates Cutaneous flush, GI distress, liver dysfunction, hyperglycemia, hyperuricemia... 

Cutaneous flush can limit compliance. Giving niacin after meals and use of aspirin may decrease flushing. 

Most of the important effects of histamine in allergic diseases, including bronchoconstriction and contraction of the gut, are mediated through HI receptors. Other effects, including the cardiovascular responses, involve both HI and H2 receptors. In man the predominant cardiovascular effect is vasodilatation and a lowering of blood pressure. This response is also responsible for the cutaneous flushing commonly observed with histamine release. The... 

Adverse effects The most common side effects of niacin therapy are an intense cutaneous flush (accompanied by an UnCOmfOrt-... 

Diffuse cutaneous flush Depressed salivation/thirst Fever... 

Tubocurarine can cause release of histamine by direct mast cell degranulation which can result in systemic effects, such as cutaneous flushing, local wheal and flare formation, hypotension, and occasionally bronch-ospasm. Preoperative oral terfenadine 60 mg + ranitidine 150 mg attenuated the reduction in blood pressure but not cutaneous flushing after the administration of tubocurarine and morphine in 60 women undergoing elective gynaecological surgery in a placebo-controlled study (122). 

Minor skin reactions lasting 5-30 minutes occur in 10-50% of patients according to various studies and are not usually associated with obvious systemic effects (10,31-34). They are probably due to histamine release. A 42% incidence of cutaneous flushing has been reported in 200 patients the effect was dose-dependent, being 18% at 0.4 mg/kg, 33% at 0.5 and 0.6 mg/kg, and 73% at 1 mg/ kg (35). One patient in this study, in the 1 mg/kg group. 

No rise in plasma histamine concentration was found with bolus doses up to 0.08 mg/kg (1), but in one case there was transient hypotension 1 minute after a bolus dose of 0.05 mg/kg via a pulmonary artery cannula, with cutaneous flushing at 2 minutes, suggesting that histamine release can occur on occasion (3). There was no tachycardia or bronchospasm, but the mean arterial pressure fell from 88 to 40mmHg and recovered with therapy within 3 minutes, by which time the skin flushing was fading. 

Reich DL. Transient systemic arterial hypotension and cutaneous flushing in response to doxacurium chloride. Anesthesiology 1989 71(5) 783-5. 

Acute hypersensitivity reactions were common during phase 1 trials of paclitaxel, and this caused delays in the completion of many trials. Reactions were mild to severe and consisted of cutaneous flushing, bronchospasm, bradycardia, and hypotension the reactions occurred after either the first or second dose (48). The mechanism of these reactions is uncertain, but they are thought to be non-immunologically mediated, and direct histamine release by mast cells is probably responsible. A large dose of Cremophor EL is used in the formulation of paclitaxel, and this may play an important part in these hypersensitivity reactions Cremophor EL induces similar reactions in dogs by direct release of histamine (4). 

Another reason the Japanese did not develop an epidemic of alcohol problems may be biological. The phenomenon of importance here is the Asian flushing response." It is a physical reaction that occurs with drinking alcohol it consists of cutaneous flushing and sometimes other symptoms, including palpitations, tachycardia, perspiration, and headache. As the name implies, the reaction occurs in Asians but not in people of other races. 

Human Toxicity Large amounts of CoCl2 depress erythrocyte production. May lead to death in children. Other effects include cutaneous flushing, chest pains, dermatitides, tinnitus, nausea and vomiting, nerve deafness, thyroid hyperplasia, myxedema, congestive heart failnre. See E. Beut-ler et al.. Clinical Disorders of Iron Metabolism (Grime Stratton, New York, 1963) pp 175-178. 

C. Toxicity Cutaneous flushing is a common adverse effect. Pretreatment with aspirin or other NSAIDs reduces the intensity of this flushing, suggesting that it is mediated by prostaglandin release. Tolerance to the flushing reaction usually develops within a few days. Dose-dependent nausea and abdominal discomfort often occur. Pruritus and other skin conditions are reported. Moderate elevations of liver enzymes and even severe hepatotoxicity may occur. Hyperuricemia occurs in about 20% of patients, and carbohydrate tolerance may be moderately impaired. 

S Cutaneous flushing, Gl distress, itching, rash. PO. Rapid, complete absorption, kidney excretion. Potentiates ganglion blocking drugs. ... 

Adverse reactions to most, but not all, of the neuromuscular blocking agents may include hypotension, bronchospasm, and cardiac disturbances. The depolarizing agents also cause an initial muscle fasciculation before relaxation. Many of these agents cause release of histamine and subsequent cutaneous (flushing, erythema, urticaria, and pruritus), pulmonary (bronchospasm and wheezing), and cardiovascular (hypotension) effects. 

D. Niacin. Histamine release results in cutaneous flushing and pruritus. 

F. Acute ingestion of niacin but not niacinamide (nicotinamide) may produce unpleasant dramatic cutaneous flushing and pruritus, which may last for a few hours. Chronic excessive use (particularly the sustained-release form) has been associated with hepatitis. 

IV. Diagnosis of vitamin overdose is usually based on a history of ingestion. Cutaneous flushing and pruritus suggest a niacin reaction but may be caused by other histaminergic agents. 

Cutaneous flushing, often associated with increased vascular permeability, leading to oedema and formation of wheals... 

Lai, E., Waters, M.G., Tata, J.R., Radziszewski, W., Perevozskaya, L, Zheng, W., Wenning, L., Connolly, D.T., Semple, G., Johnson-Levonas, A.O., Wagner, J.A., Mitchel, Y., and Paolini, J.F., 2008. Effects of a niacin receptor partial agonist, MK-0354, on plasma free fatty acids, lipids, and cutaneous flushing in humans. Journal of Clinical Lipidology. 2 375-383. 

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