Some Important Clinical Implications Related to the Use of Opioid Analgesic Drugs

8 Some Important Clinical Implications Related to the Use of Opioid Analgesic Drugs 

If bronchospasm occurs in a reaction to an OAD, the reaction is more likely to involve OAD-reactive IgE antibodies. Likewise, cardiovascular 

If appropriate OAD-reactive IgE antibody tests are available, they should be used as an adjunct to skin testing but an understanding of the immunochenucal basis of cross-reactivity between opioids and NMBDs shows that a cautionary approach to interpretation is necessary. For example, a morphine solid phase is routinely employed to detect NMBD-reactive IgE antibodies in the sera of subjects allergic to NMBDs (see Sect. 7.4.3.4.2). The structural basis of the cross-recognition is the tertiary methyl ammonium group of morphine and the substituted ammonium groups on NMBDs. 

When an OAD-induced reaction is known or suspected to be due to histamine release and the continued administration of an OAD is judged to be necessary, pretreatment with Hi and Hj (and, in future, peihaps an Hi) histanune antagonists is an option. Some opioid analgesics show differences in the amount of histanune they release and in the anatomical site where release occurs. Substitution of OADs can be made in both cases for example, fentanyl for morphine in the former case and fentanyl or morphine for buprenorphine if histamine 

Cardiovascular collapse and bronchospasm are more frequent in anaphylactic reactions to OADs 

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