Non-IgE-mediated anaphylactic reactions

HHMC can also be directly activated by agents injected intravenously for therapeutic (general anesthetics, protamine, etc.) or diagnostic purposes (radiocontrast media, etc.), which can cause non-IgE-mediated anaphylactic reactions in vitro [24,... 

Budesonide has been marketed in oral form for intestinal inflammatory disease. An non-IgE-mediated anaphylactic reaction has been associated with oral budesonide (307). 

Immunological reactions to human serum albumin tend to be non-IgE-mediated anaphylactic reactions (0.011% of cases treated), about a third of which are life-threatening (9). A case in which the mechanism seemed to be IgE-mediated anaphylaxis against native albumin has been reported (10). 

No IgE-mediated immediate-type allergic reactions to interferon alfa have ever been conclusively documented. A recurrent non-IgE-mediated anaphylactic reaction, possibly due to mast cell degranulation, has been described in a patient with mastocytosis (318). 

Another isolated case history has suggested that interferon beta-lb might have favored the development of a non-IgE-mediated anaphylactic reaction to previously well-tolerated injections of methylprednisolone (65). 

Non-IgE-mediated anaphylactic reactions to polyacrylonitrile membranes have been reported (2,3). The effects are enhacing in those using ACE inhibitors (4,5), perhaps because of an effect of bradykinin (6), which is released by the membranes (2,8,9) and whose metabolism is inhibited by ACE inhibitors. The effects also occur to a lesser extent in those taking angiotensin receptor antagonists (7) and in those with Cl esterase inhibitor deficiency (10). Treating the membranes with polyethyleneimine prevents bradykinin release (11). 

The recommendation that prolongation of the international normalized ratio (INR) to over 6.0 should be corrected vvith parenteral phytomenadione (24,25) is not accompanied by the caveat that the intravenous route entails the risk of life-threatening, non-IgE-mediated anaphylactic reactions and even death, due to the use of polyethoxylated castor oil (Cremophor EL) as a solvent (26). A severe reaction to intravenous phytomenadione has been reported (27). 

Immunologic Hypersensitivity reactions to ondansetron are rare but have been reported, including both IgE- and non-IgE-mediated anaphylactic reactions. 

Anaphylactic reactions to contrast media in most cases are not IgE-mediated (in other words they are what used to be called anaphylactoid, now called non-IgE-mediated anaphylactic reactions), and they may occur without previous sensitisation. Nor do they occur consistently in patients who have had previous reactions to contrast media. 

True IgE-mediated anaphylactic reactions to LAs are extremely rare [11-13]. Only single cases have been reported in the literature with positive prick tests [ 14,15]. A case of a positive open patch test in a patient suffering from contact urticaria after topical application of lidocaine, pilocaine mixture (Emla cream) might represent a true IgE-mediated allergy [16]. The maj ority of immediate-type reactions are non-immune in nature. 

Alfadolone and alfaxolone are two steroid anesthetics that were used in combination. However, the mixture has been withdrawn because of safety considerations regarding the solvent used, polyethoxylated castor oil (Cremophor EL), which can cause non-IgE-mediated anaphylactic (anaphylactoid) reactions (SED-10,189) (1). 

Non-IgE-mediated anaphylactic (anaphylactoid) reactions suspected to be caused by dextran as used in BCG vaccines have been described (SEDA-16, 375). 

Autacoids A 25-year-old woman had a non-IgE-mediated anaphylactic (anaphylactoid) reaction with angioedema and pulmonary edema 24 hours after starting to take oral ciprofloxacin 500 mg bd for pyelonephritis [30" ]. Ventilatory support was required for 4 days. A literature review revealed 64 cases of probable ciprofloxacin-related anaphylactoid reactions and detailed information was available in 22 patients, 10 of whom were HIV positive. The mean age was about 35 years and reactions typically developed minutes to hours after first exposure in the HIV-negative patients and from 5 minutes to 5 days of dosing in... 

Immunologic A 44-year-old, non-atopic, Caucasian woman had an IgE-mediated anaphylactic reaction to pristinamycin, confirmed by a positive skin prick test [112 ]. 

The prevalence of acute reactions to gadobutrol, a highly concentrated macro-cyclic gadohnium chelate, has been studied using prospective observational surveillance in 14 299 patients [27 ]. There was at least one adverse reaction in 78 patients (0.55%) and 2 (0.01%) were serious. One was a severe non-IgE-mediated anaphylactic (anaphylactoid) reaction and the other presented with itching and swelling of the throat. The most common adverse reaction was nausea, which occurred in 36 patients. 

Clinical manifestations show striking variations of intensity in different patients, ranging from mild hypersensitivity reactions to severe anaphylactic shock and death (table 3). However, IgE-mediated reactions are usually more severe than non-IgE-medi-ated reactions [9]. In addition, IgE-mediated reactions to NMBAs have been shown to be more severe than reactions to other substances like latex in some series [9]. 

Skin rashes due to podophyllotoxin derivatives may be hypersensitivity reactions and can be related to the drug itself or more commonly to the vehicles used. Dose-related, non-IgE-mediated hypersensitivity has been reported in 16 children receiving teniposide (118). Other published reports of hypersensitivity or anaphylactoid reactions to teniposide include degranulation of basophils (119,120), and eight anaphylactic reactions in children, all associated with the use of intravenous teniposide 150 mg/ m (121). 

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