Immediate hypersensitivity reactions

Tamagawa-Mineoka R, Katoh N, Kishimoto S Platelets play important roles in the late phase of the immediate hypersensitivity reaction. J Allergy Clin Immunol 2009 123 581-587, 587.el-9. 

Table 1. Clinical manifestations of immediate and non-immediate hypersensitivity reactions to RCM... 

The evidence that immediate hypersensitivity reactions may indeed be caused by an IgE-mediated allergic mechanism is also mainly indirect. However, some data support the concept that a subgroup of reactions may be IgE-mediated ... 

Immediate hypersensitivity reactions to RCM are associated with histamine release from basophils and mast cells [27], and extensive mast cell activation in vivo associated with clinical symptoms has been demonstrated by Earoche et al. [31]. Patients with hypersensitivity reactions after contrast medium exposure had increased plasma levels of both histamine and tryptase, and levels correlated with severity. Also other investigators have reported high levels of tryptase in connection with severe or fatal reactions [21, 33]. 

An argument against an immunologic reaction in non-immediate hypersensitivity reactions has been the lack of a hapten. Non-ionic RCM are chemically non-reactive... 

Table 3. Grade of severity for quantification of immediate hypersensitivity reactions (according to the classification from the French Society for Anesthesiology)... 

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 Rapacuronium has been withdrawn from the market in the USA. 

Hypnotics. Common hypnotics are thiopental, propofol, midazolam, etomidate, ketamine and inhaled anesthetics. The incidence of hypersensitivity reactions with thiopental is rare. Recently, thiopental was involved in less than 1% of allergic reactions in France [9]. Ever since Cremophor EL, used as a solvent for some non-barbiturate hypnotics, has been avoided, many previously reported hypersensitivity reactions have disappeared. In the last French surveys, reactions to propofol accounted for less than 2.5% of allergic reactions, and reactions to midazolam, etomidate or ketamine appear to be really rare [9]. Finally, no immune-mediated immediate hypersensitivity reaction involving isoflurane, desflurane or sevoflurane has been reported despite their wide use. 

The answer is a. (Hardman, p 224.) Epinephrine is the drug of choice to relieve the symptoms of an acute, systemic, immediate hypersensitivity reaction to an allergen (anaphylactic shock). Subcutaneous administration of a 1 1000 solution of epinephrine rapidly relieves itching and urticaria, and this may save the life of the patient when laryngeal edema and bronchospasm threaten suffocation and severe hypotension and cardiac arrhythmias become life-endangering. Norepinephrine, isoproterenol, and atropine are ineffective therapies Angioedema is responsive to antihis-... 

Weiss, M.E. and Adkinson, N.F., Immediate hypersensitivity reactions to penicillin and related antibiotics, Clin. Allergy, 18, 515, 1988. 

Schreiber s model has also proved to be a general approach to a series of oxygenated metabolites of arachidonic acid, such as lipoxin A and lipoxin B.50 The family of linear oxygenated metabolites of arachidonic acid has been implicated in immediate hypersensitivity reactions, inflammation, and a number of other health problems. Among these metabolites, several compounds, such as lipoxin A, lipoxin B, 5,6-diHETE, and 14,15-diHETE possess 1-substituted (/ )-1 -alken-3.4-diol 84 as a common substructural moiety. Therefore, the car-binol 83 is an ideal substrate for generating compound 84 by applying Sharpless epoxidation reaction.50... 

Hypersensitivity reactions Immediate hypersensitivity reactions may occur after administration of ipratropium as demonstrated by rare cases of urticaria, angioedema, rash, bronchospasm, anaphylaxis, and oropharyngeal edema. Pregnancy Category B. 

Hypersensitivity reactions Immediate hypersensitivity reactions, including angioedema, may occur after administration of tiotropium. If such a reaction occurs, stop therapy at once and consider alternative treatment. 

Hypersensitivity reactions Serious and occasionally fatal immediate-hypersensitivity reactions have occurred. The incidence of anaphylactic shock is between 0.015% and 0.04%. Anaphylactic shock resulting in death has occurred in approximately 0.002% of the patients treated. These reactions are likely to be immediate and severe in penicillin-sensitive individuals with a history of atopic conditions. 

Hypersensitivity reactions Make careful inquiry for a history of hypersensitivity reactions. Monitor patients who have had immediate hypersensitivity reactions to penicillins or cephalosporins. If an allergic reaction occurs, discontinue the drug and institute supportive treatment. Cross-sensitivity with other penicillins or -lactam antibiotics is rare. 

Pharmacology Lodoxamide is a mast cell stabilizer that inhibits the in vivo Type I immediate hypersensitivity reaction. Although lodoxamide s precise mechanism of action is unknown, the drug may prevent calcium influx into mast cells upon antigen stimulation. 

Individualistic adverse reactions to foods can occur through several different types of mechanisms (Taylor and Hefle, 2001). True allergic reactions can include both IgE-mediated immediate hypersensitivity reactions and cell-mediated delayed h)q5ersensitivity reactions (Taylor and Hefle, 2001). However, only IgE-mediafed reactions have been documented to occur with ingestion of molluscan shellfish in sensifive individuals. 

Both exocytotic and nonexocytotic mechanisms can contribute to adverse drug reactions that involve histamine release. Histamine is only one of several potent physiological mediators that are released from mast cells the other substances can also contribute to the overall immediate hypersensitivity reaction. 

HV184 Curioni A., B. Santucci, A. Cristaudo, et al. Urticaria from beer an immediate hypersensitivity reaction due to a 10-kDa protein derived from barley. Clin Exp Allergy 1999 29(3) 407-413. 

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. 

Arthus (reaction) Type III immediate hypersensitivity reaction. 

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)...

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