Pseudoallergic reactions

Mast CeU and Basophil Degraniilation by Complement Components (Anaphylatoxins) 

Whereas complement and its role in immune complex diseases have been described above (Sect. D.1.2), there appears to be a number of instances of untoward reactions to drugs in which complement activation may play a major role. Anaphylactic reactions have been described following the development of drug-specific antibodies of the IgG type capable of activating complement. In some cases, such as an immediate-type reaction following the intravenous injection of protamine sulfate (Lakin et al. 1978), homocy to tropic antibodies of IgG type capable of passively transferring the reaction have been demonstrated. Such antibodies have a short sensitization period, are stable to heating at 56 °C and seem to require complement to induce the anaphylactic reaction. 

The shocks observed after intravenous administration of plasma expanders such as dextran (Furhoff 1977) also appear to rest upon the presence of IgG-spe-cific antibodies (see Chap. 20). Whether the effect of anaphylatoxins such as C3a or C5a on the blood basophils and tissue mast cells occur following interaction of the drug with specific IgGs in solution or only after such IgGs have fixed to the mast cell membrane is not yet certain. 

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Identify the classes of drugs associated most commonly with allergic and pseudoallergic reactions. 

O Allergic and pseudoallergic reactions represent 23.8% of reported adverse drug reactions, cause considerable morbidity and mortality, and are costly. 

Radiocontrast media may cause serious immediate pseudoallergic reactions such as urticaria/angioedema, bronchospasm, shock, and death. These reactions have been reduced with the introduction of non-ionic, lower-osmolality products. 

Aspirin and NSAIDs can induce allergic and pseudoallergic reactions. Because these drugs are used so widely, with much over-the-counter use, the health care professional must have a basic understanding of the types of reactions that can occur and how to prevent them. Three types of reactions occur bron-chospasm with rhinoconjunctivitis, urticaria/angioedema, and anaphylaxis. Remember that patients with gastric discomfort... 

Based on CS s descriptions, which of the reactions represents an allergic or pseudoallergic reaction ... 

Szebeni, J. et al., Liposome-induced pulmonary hypertension in pigs properties and mechanism of a complement-mediated pseudoallergic reaction, Am. J. Physiol., 279, H1319, 2000. 

Ennis, M. et al., Histamine release and pseudoallergic reactions induced by radiographic contrast media Comparison of Angiographin, Hexabrix and Telebrix using an in vivo canine model. Agents Actions, 30, 81, 1990. 

Kallios, P. and Kallos, L. (1980). Histamine and some other mediators of pseudoallergic reactions, in, Dukor, P., Ed., Pseudoallergic reactions involvement of drug and chemicals, Karger, Basel, 115-131. 

Allergic and pseudoallergic reactions induced by gluco-corticosteroids a review. Curr Pharm Des 2003 9 1956-64. 

A pseudoallergic reaction has been reported in a patient who took several nicotinic acid-containing formulations (39). 

Any hospital ward or other place where anaphylaxis may be anticipated should have aU the drugs and equipment necessary to deal with it in one convenient kit, for when they are needed there is little time to think and none to nm about from place to place (see also Pseudoallergic reactions, p. 146). 

Stevenson DD, Sanchez-Borges M, Szczeklik A. Classification of allergic and pseudoallergic reactions to drugs that inhibit cyclooxygenase enzymes. Ann Allergy Asthma Immunol 2001 87(3) 177-80. 

There are other adverse reactions to food for which the mechanism is not fully known. These reactions are identified as idiosyncratic pseudoallergic reactions with similar clinical symptomatology (Ring et al., 2001). Elicitors of this allergy-like... 

The rate of drug metabolism, which is in part under genetic control, may be of importance. The population with low levels of hepatic acetyltransferase activity seems at greater risk of developing the hydralazine-induced lupus syndrome (Perry et al. 1970), but this does not hold for procainamide-induced lupus. Genetic factors have also been implied in pseudoallergic reactions, such as aspirin intolerance (Lockey et al. 1963). 

Pseudoallergic Reactions to Drugs Interfering with Prostaglandin Synthesis... 

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