Hypersensitivity reactions, bronchospasm caused

Rarely, a hypersensitivity reaction can cause bronchospasm or aggravation of existing asthma and a progressive fall in FEVi, resulting in dyspnea (4). 

Immunological reactions to cromoglicate can involve the pericardium, the lung, the eye, the nasal mucosa, the skin, the joints, and the liver. Rarely, a hypersensitivity reaction can cause fever (4). A survey of the world literature up to 1982 found 13 cases of facial rash, urticaria, and/or generalized dermatitis, and one of nasal congestion. In 19 patients there was bronchospasm and/or pulmonary edema, eventually culminating in shock. Four cases of eosinophilic or granulomatous pulmonary infiltration, one of liver disease and vasculitis, one of pericarditis, and three of polymyositis were reported. 

The rate of non-lgE-mediated immediate hypersensitivity reactions usually varies between 20 and 50% [1-7, 9], They are assumed to result from direct non-specific mast cell and basophil activation, which causes direct histamine release [19], Histamine release is predominantly found with the use of the benzylisoquinoUnes d-tubocurarine, atracurium and mivacurium, and the aminosteroid rapacuronium. Severe bronchospasm related to rapacuronium administration has been reported in children and adults. It might be related to the higher affinity of rapacuronium for M2 versus M3 muscarinic receptors [20]. Rapacuronium has been withdrawn from the market in the USA. 

Bruising, local irritation, mild pain, erythema, histamine-like reactions, and hematoma can occur at the site of injection. Hypersensitivity reactions involving chills, fever, urticaria, and rarely bronchospasm, nausea, vomiting, and shock have been reported in patients with HIT. Long-term UFH has been reported to cause alopecia, priapism, hyperkalemia, and osteoporosis. 

The most common side-effects to nasal administration of fluticasone are local reactions, including irritation of the nose and throat and epistaxis. Steroids may cause a raised intraocular pressure or glaucoma. Hypersensitivity reactions, including occurrence of bronchospasms, have been reported. 

NSAIDs can impair renal function, cause fluid retention, and provoke hypersensitivity reactions, including bronchospasm, aggravation of asthma, urticaria, nasal polyps, and rarely, anaphylactoid reactions. These reactions may occur even in those who have previously used NSAIDs without any ill effects. NSAIDs inhibit uterine contraction and can cause premature closure of the fetal ductus arteriosus. 

Bronchospasm occurs in more than half of the more severe hypersensitivity reactions, either on its own or as an accompaniment to other changes. It is more common, as one would expect, in asthmatic patients and in patients receiving muscle relaxants (where tracheal intubation may be a factor). It should, however, only be regarded as indicative of a reaction if other forms of airway obstruction and other causes of tracheal irritation have been excluded. 

Gonadorelin can cause headache, light-headedness, nausea, and flushing. Local swelling often occurs at subcutaneous injection sites. Generalized hypersensitivity dermatitis has occurred after long-term subcutaneous administration. Rare acute hypersensitivity reactions include bronchospasm and anaphylaxis. Sudden pituitary apoplexy and blindness have... 

Fig. 6.1 Immediate hypersensitivity reaction. These reactions are the result of the production of IgE antibody in response to an allergen. IgE binds to the mast cells via Fc receptors and its reexposure to the allergen causes degranulation and secretion of endogenous mediators. In allergic responses, TH2 cells are important in recognizing allergens in the context of MHC molecules and secrete IL-4, IL-5 and IL-13. IL-4 induces isotope switching from IgG to IgE, and IL-5 is involved in eosinophil recruitment. IL-8 serves as a chemical signal to attract neutrophils at the site of inflammation. The collective effects of endogenous mediators include rashes, inflammation, smooth-muscle contraction, bronchospasm, asthma and severe anaphylactic shock, which may even cause death (see Color Insert)...

Contraindications fc>r nonsalicylate NSAID therapy are the same as those for aspirin (see Box 7-I).The formation of a gastric ulcer or erosion that may bleed profusely is a serious potential problem with NSAIDs. Consequently, the nonsalicylate NSAIDs should be avoided or used with great caution in patients with active peptic ulcer disease. NSAIDs may increase the risk of GI complications even when used in conjunction with low-dose aspirin for cardioprotection. In addition, because of potential crosssensitivity to other NSAIDs, the nonsalicylate NSAIDs should not be given to patients in whom aspirin or other NSAIDs have caused symptoms of asthma, rhinitis, urticaria, angioedema, hypotension, bronchospasm, or of symptoms of hypersensitivity reactions. Opioids, tramadol, or acetaminophen may be suitable alternatives for patients with known or suspected susceptibility. 

Basiliximab is composed of murine sequences (30%), which can cause IgE-mediated hypersensitivity reactions. Important warnings have been released by the manufacturers regarding the possible risk of severe hypersensitivity reactions within 24 hours of initial exposure or after re-exposure after several months, based on 17 reports that included cardiac and/or respiratory failure, bronchospasm, urticaria, cytokine release syndrome, and capillary leak syndrome. 

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). 

The epipodophyllotoxins etoposide and teniposide can cause hypersensitivity reactions, which appear to be of type I (124). In a review of 93 cases, the characteristic features of the hypersensitivity reactions that occurred after intravenous etoposide included bronchospasm, facial flushing, rashes, dyspnea, fever, chills, tachycardia. 

Adverse reactions Overall, the penicillins are well tolerated. The most common adverse effects are due to hypersensitivity reactions. Hypersensitivity reactions can be simply categorized as immediate reactions (type 1) or late reactions. Type 1 reactions are IgE mediated and are often associated with systemic manifestations such as diffuse erythema, pruritus, urticaria, angioedema, and bronchospasm. The most severe yet rare IgE-mediated side effect is anaphylaxis (0.05%). Type 1 reactions usually occur within 72 hr of administration. Late reactions usually occur 72 hr after drug administration. The most common late reactions include skin rashes characterized as maculopapular or morbilliform rashes. Rarely, nafcillin may cause neutropenia. Seizures in high doses, vaginal moniliasis, and Clostridium difficile infection also can occur with all penicillins... 

There have been few reports of adverse reactions to vanillin, although it has been speculated that cross-sensitization with other structurally similar molecules, such as benzoic acid, may occur. Adverse reactions that have been reported include contact dermatitis and bronchospasm caused by hypersensitivity. ... 

Athesin contains 9 mg of alfaxalone and 3 mg of alfadolone acetate per milliliter. Following intravenous administration, athesin produces sleep within 30 seconds and also causes respiratory depression and apnea. Athesin releases histamine and may cause hypersensitivity reactions such as bronchospasm. 

D. Allergic reactions (bronchospasm, hives, and shock) are uncommon and occur almost exclusively with ester-linked local anesthetics. Methylparaben, used as a preservative in some multidose vials, may be the cause of some reported hypersensitivity reactions. 

Hydrocodone bitartrate is absolutely contraindicated in patients with known hypersensitivity reactions to hydrocodone. Commercial preparations may also contain sulfite compounds that can produce allergic reactions, including bronchospasm and anaphylaxis, in certain susceptible individuals, particularly asthmatic patients. In addition, the dye tartrazine is present in one preparation of hydrocodone bitartrate, combined with chlorpheniramine maleate and phenylephrine hydrochloride, that is used as an antitussive and expectorant agent (Vanex). Also known as FD C yellow No. 5, tartrazine can cause asthmatic and other allergic reactions in some susceptible patients, especially those with aspirin sensitivities. 

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