Drug-induced anaphylaxis and anaphylactoid reactions have increased in frequency with more widespread use of pharmaceutical agents. Anaphylaxis is a systemic, severe immediate hypersensitivity reaction caused by immunoglobulin (Ig) E-mediated immunological release of mediators of mast cells and basophils. An anaphylactoid reaction is an event similar to anaphylaxis but is not mediated by IgE.
The incidence of anaphylactic or anaphylactoid reactions differs amongst classes of medications. Antibacterials are the most usual offenders, and penicillins are the most studied. Other compounds commonly causing reactions include nonsteroidal anti-inflammatory drugs, anaesthetics, muscle relaxants, latex and radiocontrast media.
Prevention, if possible, is the purpose of detailed patient history taking and physical examination. Simple strategies can be employed to decrease the risk of anaphylaxis. These include consideration of the route of drug administration, identification of patients with known causes of anaphylaxis, and the knowledge that certain medications cross react and are contraindicated in those with known history of anaphylaxis. Tests are available, and include IgE-specific skin tests and radioallergosorbent tests. Penicillins are the only compounds whose antigenic determinants are well documented, it is therefore difficult to determine the negative predictive value of other compounds tested. Oral challenge remains an alternative, though entails risk. Desensitisation procedures, as well as gradual dose escalation protocols, are available and can be implemented based on patient history and diagnostic testing.
The management of anaphylaxis is based on control of the airway, breathing and circulation. Treatment consists of epinephrine (adrenaline) and supportive measures. Rapid diagnosis and intervention are important in these life-threatening reactions. After stabilisation, all individuals with a documented history of anaphylaxis require a Medic-Alert bracelet or necklace, and an identification card for their wallet or purse.
Mast Cell Skin Test Anaphylactoid Reaction Positive Skin Test Oral Challenge
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Kagy L, Blaiss MS. Anaphylaxis in children. Pediatr Ann 1998 Nov; 27(11): 727–34PubMedGoogle Scholar
Freeman TM. Anaphylaxis: Diagnosis and Treatment. Primary Care; Clinics in Office Practice 1998 Dec; 25(4): 809–17PubMedCrossRefGoogle Scholar
Hess DA, Rieder MJ. The Role of Reactive Drug Metabolites in Immune-Mediated Adverse Drug Reactions. Ann Pharmacother 1997 Nov; 31(11): 1378–87PubMedGoogle Scholar
Macy E. Elective penicillin skin testing and amoxicillin challenge: Effect on outpatient antibiotic use, cost and clinical outcomes. J Allergy Clin Immunol 1998 Aug; 102(8): 281–5PubMedCrossRefGoogle Scholar
Lieberman P. Anaphylaxis and Anaphylactiod Reactions. In: Middleton E, Reed CE, Ellis EF, et al., editors. Allergy principles and practice. St. Louis: Mosby, 1998: 1079–91Google Scholar
Douglas DM, Sukenick E, Andrade WP et al. Biphasic systemic anaphylaxis: An inpatient and outpatient study. J Allergy Clin Immunol 1994 Jun 93(6): 977–85PubMedCrossRefGoogle Scholar
Atkinson TP, Kaliner MA. Anaphylaxis. Med Clin Nor Am 1992; 76: 841–55Google Scholar
Boston Collaborative Drug Surveillance Program: Brief reports: drug induced anaphylaxis, JAMA 1973; 224: 613Google Scholar
Porter J, Jick H. Boston Collaborative Drug Surveillance Programs: drug induced anaphylaxis, convulsions, deafness and extrapyramidal symptoms. Lancet 1977; I: 587CrossRefGoogle Scholar
Amornmarn L, Bernard L, Kumar N, et al. Anaphylaxis admissions to a university hospital. J allergy Clin Immunol 1992; 89Suppl.: 349Google Scholar
Bresser H, Sander C, Rakoski J. Anaphylactic emergencies in Munich. J Allergy Clin Immunol 1995; 95: 386Google Scholar
Klein JS, Yocum MN. Underreporting of anaphylaxis in a community emergency room. J Allergy Clin Immunol 1995; 95: 637–8PubMedCrossRefGoogle Scholar
Yocum MW, Butterfield JH, Klein JS, et al. Epidemiology of anaphylaxis in Olmstead County: a population-based study. J Allergy Clin Immunol 1999: 104: 452–6PubMedCrossRefGoogle Scholar
Weiss ME, Atkinson NF. Immediate hypersensitivity reactions to penicillin and related antibiotics. Clin Allergy 1988: 18: 515–40PubMedCrossRefGoogle Scholar
Manning ME, Stevenson DD, Mathison DA. Reactions to aspirin and other nonsteroidal anti-inflammatory drugs. Immunol Allergy Clin North Am 1992 Mar; 12(3): 611–31Google Scholar
Strom BL, Carson JUL, Morse ML, et al. The effect of indication on hypersensitivity reactions associated with zomepirac sodium and other non-steroidal anti-inflammaotry drugs. Arthritis Rheum 1987; 30: 1142PubMedCrossRefGoogle Scholar
Settipane GA, Chafee FH, Klein DE. Aspirin intolerance: II. A prospective study in an atopic and normal population. J Allergy Clin Immunol 1974; 53: 200PubMedCrossRefGoogle Scholar
Laxenaire MC, Moneret-Vautrin DA, Widmer S, et al. Substances anesthesiques responsables de chocs anaphylactiques. Enquete multicentrique francaise. Ann Fr Anesth Reanim 1990; 9: 501–6PubMedCrossRefGoogle Scholar
Laxenaire MC, Le Groupe d’etude des reactions anaphylactoides peranesthesiques. Substances responsables des chocs anaphylactiques peranesthesiques: troisieme enquete multicentrique francaise (dy1992-1994). Ann Fr Anesth Reanim 1996; 15: 1211–8PubMedCrossRefGoogle Scholar
Gueant JL, Aimone-Gastin I, Namour F, et al. Diagnosis and pathogenesis of the anaphylactic and anaphylactoid reactions to anaesthetics. Clin Exp Allergy 1998; 28: 65–70PubMedCrossRefGoogle Scholar
Eggleston ST, Lush LW. Understanding allergic reactions to local anesthetics. Ann Pharmacother 1996; 30: 851–7PubMedGoogle Scholar
Giovannitti JA, Bennett CK. Assessment of allergy to local anesthesia. J Am Dent Assoc 1979; 98(5): 701–6PubMedGoogle Scholar
Lagier F, Vervloet D, Lhermet I et al. Prevalance of latex allergy in operating room nurses. J Allergy Clin Immunol 1993; 90: 319–22CrossRefGoogle Scholar
Kelly KJ, Walsh-Kelly CM. Latex allergy: A patient and health care system emergency. J Emerg Nurs 1998 Dec; 24(6): 539–45PubMedCrossRefGoogle Scholar
Latex Hypersensitivity Committee of the American College of Allergy, Asthma, and Immunology: Latex allergy an emerging health care problem. Ann Allergy Asthma Immunol 1995; 75: 19–21Google Scholar
Katayama H, Yamaguchi K, Kozuka T, et al. Adverse reactions to ionic and nonionic contrast media: a report from the Japanese Committee on the Safety of Contrast Media. Radiology 1990; 175: 621PubMedGoogle Scholar
Adkinson FN. Drug allergy. In: Middleton E, Reed C, Ellis EF, et al., editors. Allergy principlesand practice. St Louis: Mosby, 1998: 1217Google Scholar
Craig TJ, Mende C. Common allergic and allergic-like reactions to medications. Postgrad Med 1999 Mar; 105(3): 173–81PubMedCrossRefGoogle Scholar
Sogn DD, Evans III R, Shepard GM, et al. Results of the National Institutes of Allergy and Infectious Diseases Collaborative Clinical Trial to test the predictive value of skin testing with major and minor penicillin derviatives in hospitalized adults. Arch Intern Med 1992; 152: 1025–32PubMedCrossRefGoogle Scholar
Pichichero ME, Pichichero DM. Diagnosis of penicillin, amoxicillin and cephalosporin allergy: reliability of examination assessed by skin testing and oral challenge. J Pediatr 1998 Jan; 132: 137–43PubMedCrossRefGoogle Scholar
Vervloet D, Arnaud A, Vellieux P, et al. Anaphylactic reactions to muscle relaxants under general anesthesia. J Allergy Clin Immunol 1979; 63: 348PubMedCrossRefGoogle Scholar
Lieberman P. Difficult allergic drug reactions. Immunol Allergy ClinNorthAm 1991; 11(1): 331Google Scholar