652 Acute IgE-mediated generalized urticaria-angioedema after topical application of povidone-iodine

Sáez, Miguel; Prieto, A.; Olalde, S.; Armentia, L.; Baeza, M.L.; Montoro, A.; de, M. Barrio

doi:10.1016/s0091-6749(96)80870-0

Cited by 10 publications

(17 citation statements)

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“…Although povidone-iodine (betadine) is a commonly applied topical antiseptic solution, anaphylaxis to this compound is rare (14,19,30,59,(173)(174)(175)(176)(177). Clinical suspicion of povidone-iodine anaphylaxis was generally corroborated by skin test and basophil activation assays.…”

Section: Chlorhexidine and Other Antisepticsmentioning

confidence: 99%

Anaphylaxis during anaesthesia: diagnostic approach

Ebo¹,

Fisher²,

Hagendorens³

et al. 2007

Allergy

190

197

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Anaesthesiologists administer several drugs while providing general anaesthesia. Many of these drugs can elicit adverse drug reactions that fall apart into two major types. First, reactions that are usually dose-dependent and related to the pharmacological properties of the drug and/or its metabolites. Second, reactions that are unrelated to the drug's pharmacological characteristics and that are less dose-dependent. These reactions comprise drug intolerance, idiosyncratic reactions and drug-induced immune-mediated allergic and nonimmune-mediated so-called pseudo-allergic or anaphylactoid reactions. The terms anaphylactic and anaphylactoid, however, have been used inconsistently in the literature. Therefore, the nomenclature task force set up by the European Academy of Allergy and Immunology (EAACI) has proposed that anaphylactic-type reactions should be reclassified into allergic anaphylaxis and nonallergic anaphylaxis. Allergic anaphylaxis being further subdivided in IgE-mediated and non-IgE-mediated reactions (1).The exact prevalence of anaphylaxis during anaesthesia is difficult to ascertain. The estimated overall frequency has been reported to vary between 1 in 3500 and 1 in 13 000 procedures in French series (2, 3) and between 1 in 10 000 and 1 in 20 000 in an Australian study (4). The clinical manifestation of these reactions is not infrequently an almost immediate generalized response with bronchospasm and hypotension. The degree of severity varies and does not allow differentiation between an IgE-mediated or non-IgE mediated reaction resulting from nonspecific mediator release (5). The mortality from these reactions is in the range from 3 to 6%, and an additional 2% of patients experience significant residual brain damage (4).Diagnosis of anaphylaxis during anaesthesia is not always straightforward. It can be hampered as a broad spectrum of different drugs can elicit heterogeneous allergic and nonallergic reactions with distinct and sometimes unclear pathological mechanisms. Problems are certainly compounded as multiple drugs need to be administered during general anaesthesia. In addition, nonanaesthesia related drugs or procedures (e.g. disinfection) are sometimes administered/performed in the perioperative period and can also be the cause of an allergic reaction.In addition, none of the available diagnostic tests demonstrates absolute accuracy. False-positive test Correct management of anaphylaxis during anaesthesia requires a multidisciplinary approach with prompt recognition and treatment of the acute event by the attending anaesthesiologist, and subsequent determination of the responsible agent(s) with strict avoidance of subsequent administration of all incriminated and/or cross-reacting compounds.However, correct identification of the causative compound(s) and safe alternatives is not always straightforward and, too often, not done.This review is not intended to discuss acute management of anaesthesia-related anaphylaxis but summarizes the major causes of anaphylaxis during anaesthesia and the di...

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Section: Chlorhexidine and Other Antisepticsmentioning

confidence: 99%

Anaphylaxis during anaesthesia: diagnostic approach

Ebo¹,

Fisher²,

Hagendorens³

et al. 2007

Allergy

190

197

View full text Add to dashboard Cite

show abstract

“…1 The low rates of documentation in the ED are in stark contrast to a study that found that 98% of patients admitted to an Australian inpatient paediatric unit had their immunisation status recorded. 2 The most frequent recorded parameters were weight and immunisation status.…”

Section: Paediatric Assessment In a General Metropolitan Emer-gency Dmentioning

confidence: 88%

“…Fewer than 10 documented IgE-mediated allergic reactions have been reported following povidone-iodine exposure, occurring after topical, vaginal or rectal applications. [1][2][3][4] The allergenic determinant in cases of immediate hypersensitivity is thought to be povidone, based on the presence of IgE antibodies to povidone in the serum of allergic patients, 1 and the occurrence of anaphylaxis to povidone without iodine, 5 including in a child who had previously reacted to Betadine. 6 Povidone is a mixture of synthetic polymers, 7 which is widely distributed, being used as an additive in food products, a dispersant in hairsprays, a suspending and coating agent in tablets, a film forming compound for eyedrops and a retardant for subcutaneous injections.…”

Section: Dear Editor Recurrent Anaphylaxis Caused By Topical Povidonmentioning

confidence: 99%

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Recurrent anaphylaxis caused by topical povidone‐iodine (Betadine)

Gray

Katelaris

Lipson

2013

J Paediatrics Child Health

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“…Parabens [75], benzyl alcohol [76] and polyvinylpirolidone, or povidone-iodine [77,78] are other preservatives responsible for immediate hypersensitivity reactions, which might be erroneously attributed to GCs. In particular, specific IgE to povidone-iodine, a synthetic polymer of high molecular weight [77], have been detected in a case of generalized urticaria-angioedema after its topical application [78].…”

Section: The Etiologic Role Of Preservativesmentioning

confidence: 99%

Cross-Reactivity in Cell-Mediated and IgE-Mediated Hypersensitivity to Glucocorticoids

Ventura

Calogiuri²,

Muratore³

et al. 2006

CPD

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In the last few decades, glucocorticoids have received increasing attention for their capability of provoking systemic hypersensitivity reactions, when administered orally, parenterally, or intralesionally, as well as allergic skin and mucosal symptoms, when applied locally to the skin in patients with contact dermatitis or to the mucosa in patients with asthma and/or rhinitis. However, because of their anti-inflammatory and immunosuppressive properties, glucocorticoids are often not suspected of such hypersensitivity reactions. In addition, because glucocorticoids retain their anti-inflammatory potential, even if they act as sensitizers, the signs and symptoms of allergic reactions are not always obvious, particularly when they overlap with those caused by the very diseases glucocorticoids are used to treat. Moreover, interpretation of diagnostic tests, specifically that of patch-test reactions, can be difficult. In this review, particular attention is addressed to the problem of allergenic cross-reactivity among topical and systemic glucocorticoids. We also look at the clinical and practical aspects of both cell-mediated and IgE-mediated hypersensitivity reactions to glucocorticoids and their consequences on anti-inflammatory therapeutic choices.

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652 Acute IgE-mediated generalized urticaria-angioedema after topical application of povidone-iodine

Cited by 10 publications

References 0 publications

Anaphylaxis during anaesthesia: diagnostic approach

Anaphylaxis during anaesthesia: diagnostic approach

Recurrent anaphylaxis caused by topical povidone‐iodine (Betadine)

Cross-Reactivity in Cell-Mediated and IgE-Mediated Hypersensitivity to Glucocorticoids

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