Abstract
Purpose
A rare case of an anaphylactoid reaction to maltose solution is presented.
Clinical features
A 28-yr-old man underwent repair of bilateral inguinal hernia under spinal anaesthesia with dibucaine. At the end of operation, he developed generalized flush and circulatory collapse immediately after receiving Na acetate solution containing maltose, 5%, iv. The reactions were treated with 32 mg ephedrine and 250 mg methylprednisolone iv, and rapid infusion of 1,000 ml acetated Ringer’s solution. The skin tests provoked positive responses to maltose solutions.
Conclusion
The clinical features and skin tests suggested that the episode was an anaphylactoid reaction to maltose. Maltose is one of the dissacharides (MW: 342) produced from starch and glycogen. Maltose solutions are used frequently in Japan as a carbohydrate source. Further study is required to confirm whether maltose has an immunological antigen-eliciting activity.
Résumé
Objectif
Présenter une rare observation de réaction anaphylactoïde au maltose.
Éléments cliniques
Un homme de 28 ans a subi une cure bilatérale de hernie inguinale sous rachianesthésie à la dibucaïne. À la fin de l’intervention, il a présenté un érythème généralisé et un collapsus circulatoire après l’administration d’acétate de Na contenant du maltose à 5% iv. La réaction a été traitée avec 32 mg d’éphédrine et 250 mg de méthylprednisolone iv avec une perfusion rapide de 1000 ml d’une solution de Ringer avec acétate. L’intradermoréaction était positive aux solutions de maltose.
Conclusion
Les élément cliniques et les épreuves cutanées suggèrent une réaction anaphylactoïde au maltose. Le maltose est un dissacharide (PM : 342) provenant de l’amidon et du glycogène. Au Japon, on administre souvent des solutions de maltose comme sources d’hydrates de carbone. Des épreuves supplémentaires sont nécessaires pour confirmer l’action antigénique du maltose.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Stoelting RK. Allergic reactions during anesthesia. Anesth Analg 1983; 62: 341–56.
Withington DE. Allergy, anaphylaxis and anaesthesia. Can J Anaesth 1994; 41: 1133–9.
Weser E, Sleisenger MH. Metabolism of circulating disaccharides in man and the rat. J Clin Invest 1967; 46: 499–505.
Siraganian RP, Hook WA. Histamine release and assay methods for the study of human allergy.In: Rose NR, Friedman H, Fahey JL (Eds.). Manual of Clinical Laboratory Immunology, 3th ed. Washington, D.C. American Society for Microbiology 1986: 675–84.
Kniker WT, Hales SW, Lee LK. Diagnostic methods to demonstrate IgE antibodies: skin testing techniques. Bull NY Acad Med 1981; 57: 524–48.
Fisher M. Intradermal testing after anaphylactoid reac tion to anaesthetic drugs: practical aspects of perfor mance and interpretation. Anaesth Intensive Care 1984; 12: 115–20.
Watkins J. Investigation of allergic and hypersensitivity reactions to anaesthetic agents. Br J Anaesth 1987; 59: 104–11.
Leynadier F, Sansarricq M, Didier JM, Dry J. Prick tests in the diagnosis of anaphylaxis to general anaes thetics. Br J Anaesth 1987; 59: 683–9.
Moneret-Vautrin DA, Laxenaire MC. Skin tests in diag nosis of allergy to muscle relaxants and other anesthetic drugs. Monogr Allergy 1992; 30: 145–56.
Watkins J. Heuristic decision-making in diagnosis and management of adverse drug reactions in anaesthesia and surgery: the case of muscle relaxants. Theor Surg 1989; 4: 212–22.
Bochner BS, Lichtenstein LM. Anaphylaxis. N Engl J Med 1991; 324: 1785–90.
Southgate DAT. Digestion and metabolism of sugars. Am J Clin Nutr 1995; 62: 203S-11.
Young SJM, Weser E. The metabolism of circulating maltose in man. J Clin Invest 1971; 50: 986–91.
Sprandel U, Heuckenkamp P-U, Zöllner N. Utilization of intravenous maltose. Nutr Metabol 1975; 19: 96–102.
Ishii H, Shima T, Hoshi K, Iwatsuki N, Hashimoto Y. A case of anaphylactoid reactions to lactated Ringer’s solution with 5% maltose. (Japanese) Masui 1989; 38: 1217–21.
Kimura M, Sunami K, Takeda A. Two cases of anaphylactic shock induced by chlorhexidine gluconate and maltose. (Japanese) Masui To Sosei 1994; 30: 319–22.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Enokibori, M., Kuge, M. & Mori, K. Anaphylactoid reaction to maltose 5% solution during spinal anaesthesia. Can J Anaesth 45, 52–55 (1998). https://doi.org/10.1007/BF03011993
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03011993