Drug-induced histamine release

Hypersensitivity responses occur shortly after rapid IV drug perfusion and include hypotension, fever, chills, urdcaria, and bronchospasm. The fact that about a third of all reactions occur following the drst exposure to the drug and that the severity of the responses is dose related suggest that this is not a true immune response to the drug but may be related to a drug-induced histamine release. 

Short-term administration of barbiturates has no clinically significant effect on the hepatic, renal, or endocrine systems. A single induction dose of thiopental does not alter tone of the gravid uterus, but may produce mild transient depression of newborn activity. Drug-induced histamine release is occasionally seen. Barbiturates can induce fatal attacks of porphyria in patients with acute intermittent or variegate porphyria and are contraindicated in such patients. Unlike inhala-tional anesthetics and succinylcholine, barbiturates and all other parenteral anesthetics apparently do not trigger malignant hyperthermia. 

Tubocurarine may Induce histamine release and promote ganglionic blockade. The drug can also lower blood pressure. 

The chemically similar teicoplanin, not approved in the USA, is not inferior to vancomycin with regard to efficiency of treating grampositive infections. It shows a lower rate of adverse reactions, particularly nephrotoxicity and, as already discussed, is used as a substitute for vancomycin in red man syndrome. When hypersensitivity reactions do occur with teicoplanin they are generally of the delayed type, but there are a few documented cases of apparent IgE antibody-mediated reactions implicated, for example, by an immediate wheal and flare skin reaction to the drug or by teicoplanin-induced histamine release from a patient s basophils. Despite the chemical and pharmacological... 

D-tubocurarine can induce a release of histamine which results in a massive drop of blood pressure, an increase of saliva and mucus secretion and laryn-gal and bronchospasms, which can interfere with the intubation. In patients with asthma bronchiale on an allergic basis the use of this drug should be avoided. Due to its ganglion blocking properties D-tubocurarine can induce a histamine-independent drop in blood pressure. 

Histamine may be released from mast cells by mechanisms that do not require prior sensitization of the immune system. Drugs, high-molecular-weight proteins, venoms, and other substances that damage or disrupt cell membranes can induce the release of histamine. Any thermal or mechanical stress of sufficient intensity also will result in histamine release. Cytotoxic compounds, may release histamine as the result of disruption of cell membranes. 

Diphenhydramine, like other antihistamines, is most often used to provide symptomatic relief of allergic symptoms caused by histamine release. The drug is also used as an antitussive, a nighttime sleep aid for the short-term treatment of insomnia, and as a preventive and treatment for motion sickness. Diphenhydramine may be useful in the treatment of parkinsonian syndrome in geriatric patients including drug-induced ex-trapyramidal reactions. Diphenhydramine has been used topically for the temporary relief of pruritus and pain associated with various skin conditions including minor burns, insect bites, and minor skin irritation. 

The histamine release in the brain, and perhaps other sites, involves exocytosis, as this potassium-induced release is a calcium-dependent process. Histamine is released by many factors. For example, histamine is released by numer-ons drugs including reserpine, codeine, meperidine, hydralazine, morphine, d-tnbocurarine, dextrans, papaverine, and compound 48/80. However, the different histamine storage sites show certain degrees of specificity. For example, the histamine in mast cells is not released following potassium-induced depolarization or by reserpine, factors that release histamine from nenrons. Conversely, compound 48/80, which releases histamine from mast cells, is not able to release histamine from nenrons. 

Furthermore hoveniodulciosides Al, A2, B1 and B2 (70-73), from 16,17-seco-dammarane triterpene glycosides from Chinese drug Hovenia dulcis were found to inhibit the histamine release from rat peritoneal exsudate cells induced by compound 48/80 and calcium ionophore A-23187 [93],... 

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