Urticaria intravenous

The indications for Hi-antihistaminics are derived from their mechanism of action all conditions in which a histamine release, mainly as sequel of an allergic reaction (bronchial asthma, hey fever, urticaria, allergic reactions to food or drugs), dominates the clinical symptoms. They can be used pro-phylactically or in acute situations, even by intravenous application. 

Indications for use of parenteral iron, e.g. as fer-rioxidesaccharate or iron dextran, are in patients on hemodialysis and patients with a disease which prevents absorption from the gastrointestinal tract, in patients who are on long term parenteral nutrition and sometimes in patients with inflammatory bowel disease. Parenteral iron does not raise the hemoglobin level significantly faster than oral therapy and carries a risk of severe adverse reactions. Reactions to intravenous iron include headache, malaise, fever, arthralgias, urticaria and in rare cases anaphylactic reactions, which may be fatal. 

Most of the adverse reactions associated with the use of the intravenous barbiturates are predictable and therefore can be controlled or avoided. Some reactions, such as hypersensitivity, are entirely unpredictable. Particularly patients with asthma, urticaria, or an-gioedema may acquire allergic hypersensitivity to the barbiturates. Acute intermittent porphyria is an absolute contraindication to the use of barbiturates. 

Histamine was synthesized in 1907 and later isolated from mammalian tissues. Early hypotheses concerning the possible physiologic roles of tissue histamine were based on similarities between the effects of intravenously administered histamine and the symptoms of anaphylactic shock and tissue injury. Marked species variation is observed, but in humans histamine is an important mediator of immediate allergic (such as urticaria) and inflammatory reactions, although it plays only a modest role in anaphylaxis. Histamine plays an important role in gastric acid secretion (see Chapter 62) and functions as a neurotransmitter and neuromodulator (see Chapters 6 and 21). Newer evidence indicates that histamine also plays a role in chemotaxis of white blood cells. 

Unithiol has been reported to have a low overall incidence of adverse effects (< 4%). Self-limited dermatologic reactions (drug exanthems or urticaria) are the most commonly reported adverse effects, although isolated cases of major allergic reactions, including erythema multiforme and Stevens-Johnson syndrome, have been reported. Because rapid intravenous infusion may cause vasodilation and hypotension, unithiol should be infused slowly over an interval of 15-20 minutes. 

Infliximab intravenous infusions result in acute adverse infusion reactions in up to 10% of patients, but discontinuation of the infusion for severe reactions is required in less than 2%. Infusion reactions are more common with the second or subsequent infusions than with the first. Early mild reactions include fever, headache, dizziness, urticaria, or mild cardiopulmonary symptoms that include chest pain, dyspnea, or hemodynamic instability. Reactions to subsequent infusions may be reduced with prophylactic administration of acetaminophen, diphenhydramine, or corticosteroids. Severe acute reactions include significant hypotension, shortness of breath, muscle spasms, and chest discomfort such reactions may require treatment with oxygen, epinephrine, and corticosteroids. 

Most conventional antihistamines are available for both oral and. intravenous or intramuscular administration. In serious cases of urticaria (hives), for example, tire injection rather than oral route is most effective. The major excretion route for most antihistamines is hepatic (liver), occurring within 4 to 15 hours. 

An anaphylactoid reaction occurred in a 68-year-old woman after treatment with intravenous methylprednisolone for asthma. She had developed urticaria with methylprednisolone 1 year earlier, but the reaction had been thought to be related to the solvent in the formulation (302). 

A 28-year-old nurse had generalized urticaria and collapsed while she was undergoing a gastroscopy for suspected Helicobacter pylori infection (24). Before the start of the procedure she was given lidocaine oral spray and intravenous diazepam 10 mg, and at the end intravenous flumazenil 1 mg. Skin prick tests and intradermal tests with diazepam 5 mg/ml produced a weal-and-flare reaction flumazenil 0.1 mg/ml and lidocaine 2% had no effect. 

A 19-year-old man developed generalized urticaria, intense pruritus, and mild bronchospasm 30 minutes after injecting cocaine for the third time. He had weals on the face, neck, arms, and chest, and scattered wheezing in the lungs. Urine toxicology screen was positive for cocaine metabolites. His symptoms resolved several hours after the administration of Hi receptor antihistamines and intravenous glucocorticoids. 

This compound chelates cyanide as cobalticyanide. This drug is known to antagonize cyanide more quickly than the nitrites but its clear superiority has not been established. Intravenous administration of 300 mg of dicobalt edetate in glucose solution is the current treatment of choice in France and the United Kingdom. Serious side effects like vomiting, urticaria, anaphylactoid shock, hypotension, and ventricular arrythmias have been reported in patients receiving Kelocyanor (Van Heijst and Meredith, 1990). 

DOT CLASSIFICATION 8 Label Corrosive SAFETY PROFILE Moderately toxic by ingestion, skin contact, intravenous, and subcutaneous routes. Mildly toxic by inhalation. A skin and severe eye irritant. Excessive absorption can cause urticaria, vomiting, diarrhea, blurred vision, and weakness. Combustible when exposed to heat or flame can react vigorously with oxidizing materials. Explodes on contact with dicyanofurazan. To fight fire, use alcohol foam, mist, dr) chemical, water spray. When heated to decomposition it emits highly toxic fumes of NOx. 

Adverse effects. General reactions include headache, dizziness, nausea, vomiting, disorientation, pressure sensations in the chest, myalgia, hypotension, a metallic taste, urticaria and hypersensitivity. Intravenous iron may rarely cause anaphylactoid reactions and facilities for cardiopulmonary resuscitation should be available. 

Management guidelines for the treatment of anaphylactoid reactions to intravenous acetylcysteine have been developed. Patients who develop only flushing of the skin require no treatment. Urticaria should be treated with diphenhydramine and acetylcysteine infusion can be continued. If angioedema or respiratory distress occur, diphenhydramine should be given and the acetylcysteine infusion stopped it can be restarted 1 hour after the administration of diphenhydramine if no sjmptoms are present (SEDA-22,195). 

The main adverse effect of bepridil is torsade de pointes due to QT interval prolongation. After intravenous infusion bepridil can cause local reactions (3) and phlebothrombosis (4). Other minor adverse effects that have been reported include urticaria (5), gastrointestinal disturbances (especially diarrhea) (6,7), and dizziness (6-8). Hepatic enzymes can rise (9,10). 

A 25-year-old man with symptoms of acute gastroenteritis took Pepto-Bismol, a total of eight caplets over 6 hours. About 30 minutes after the last dose, he developed generalized acute urticaria. He had previously tolerated Pepto-Bismol well, but had presumably become sensitized. He was successfully treated with intravenous fluids and histamine Hi receptor antagonists. 

Adverse respiratory effects are uncommon with calcium channel blockers. However, three cases of acute broncho-spasm accompanied by urticaria and pruritus have been reported in patients taking verapamil (51), and a patient with Duchenne-type muscular dystrophy developed respiratory failure during intravenous verapamil therapy for supraventricular tachycardia (52). Recurrent exarcer-bations of asthma occurred in a 66-year-old lady with hypertension and bronchial asthma given modified-release verapamil (53). 

A 44-year-old woman chewed a castor bean seed and within minutes developed urticaria, drowsiness, Quincke s edema, and extreme hypotension. Her anaphylactic shock was treated with adrenaline, intravenous glucocorticoids, antihistamines, and intravenous fluids. She quickly recovered and a subsequent blood test demonstrated CAP-RAST to castor beans. 

An 80-year-old woman had a colonic resection for Duke s C stage adenocarcinoma and was then given fluorouracil 400 mg/m /day and folinic acid 200 mg/m /day for 5 days every 4 weeks. She later developed metastases and a second course of chemotherapy included irinotecan (180 mg/m ), fluorouracil 400 mg/m, followed by a continuous infusion of 2400 mg/m over 2 days, folinic acid 200 mg/m, ondansetron, and atropine. During the first course of chemotherapy she developed urticaria following the administration of ondansetron and folinic acid. The ondansetron was withdrawn and replaced by metoclopramide and prednisone. During the next course, just after the administration of folinic acid, metoclopramide, and prednisone, she had more urticaria and profound hjrpotension and required intravenous adrena-hne. Folinic acid was withdrawn and subsequent courses were uneventful... 

Skin reactions to intravenous immunoglobulin are rare (52,93-95). Other reported reactions include urticaria, maculopapular rashes, petechiae, eczema, and erythema multiforme (31,96). 

Infusion of intravenous immunoglobulin 0.14 g/kg in 17 patients with autoimmune diseases, in whom circulating immunoglobulins had been depleted, was associated with a high incidence of serious adverse effects (94). Treatment was terminated in four patients because of adverse effects, including urticaria, severe hypotension, arthralgia, and chest discomfort. 

When 20 patients each received 40 ml of 0.5% chloroprocaine or 0.5% lidocaine for intravenous regional anesthesia, chloroprocaine caused a significantly higher incidence of urticaria (28 versus 0%) than lidocaine when the study was repeated using alkalinized instead of plain chloroprocaine, there was no significant difference between the groups (280). 

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