Opioids anaphylaxis

Opioids. Reactions to morphine, codeine phosphate, meperidine, fentanyl and its derivatives are uncommon. Because of their direct histamine-releasing properties, especially regarding morphine and codeine, distinction between anaphylaxis and non-immune-mediated histamine release is not always easy. Only 12 cases were recorded in the last 2 years epidemiologic survey in France, 9 of them being related to morphine administration [9]. 

Flurazepam (Dalmane) [C-IV] [Sedative/Hypnotic/ Benzodiazepine] Uses Insomnia Action Benzodiazepine Dose Adults Beds >15 y. 15-30 mg PO qhs PRN X in elderly Caution [X, /-] Elderly, low albumin, hepatic impair Contra NAG PRG Disp Caps SE Hangover d/t accumulation of metabolites, apnea, anaphylaxis, angioedema, amnesia Interactions T CNS depression W/ antidepressants, antihistamines, opioids, EtOH T effects OF digoxin, phenytoin T effects W/ cimetidine, disulfiram, fluoxetine, iso-niazid, ketoconazole, metoprolol, OCPs, propranolol, SSRIs, valproic acid. 

In mucosal sheets from porcine ileum, the delta opioid agonist DPDPE inhibits saxitoxin-sensitive elevations in neurogenic ion transport evoked by histamine [142], tryptase-like enzymes [143], serotonin [144], kallidin [145], and type I hypersensitivity [142]. These effects of DPDPE are inhibited by naltrindole. In contrast, elevations in neurogenic ion transport occurring secondary to an immediate hypersensivity reaction in the guinea pig ileal mucosa are augmented by DPDPE, indicating that the neuromodulatory actions of opioids on active mucosal transport evoked by inflammation or anaphylaxis may depend on the species examined [146],... 

Baldo BA, Fisher MM. Diagnosis of IgE-dependent anaphylaxis to neuromuscular blocking drugs, thiopentone and opioids. Ann Fr Anesth Reanim. 1993 12 173-81. 

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