Allergy to illicit drugs and narcotics

Abstract

Despite their frequent use, allergy to illicit drugs and narcotics is rarely reported in literature. We present a review of the different classes of drugs of abuse that might be involved in allergies: central nervous system (CNS) depressants (such as cannabis, opioids and kava), CNS stimulants (cocaine, amphetamines, khat and ephedra) and hallucinogens such as ketamine and nutmeg. Diagnosis of drug and narcotic allergy generally relies upon careful history taking, complemented with skin testing eventually along with quantification of sIgE. However, for various reasons, correct diagnosis of most of these drug allergies is not straightforward. For example, the native plant material applied for skin testing and sIgE antibody tests might harbour irrelevant IgE-binding structures that hamper correct diagnosis. Diagnosis might also be hampered due to uncertainties associated with the non-specific histamine releasing characteristics of some compounds and absence of validated sIgE tests. Whether the introduction of standardized allergen components and more functional tests, that is, basophil activation and degranulation assays, might be helpful to an improved diagnosis needs to be established. It is anticipated that due to the rare character of these allergies further validation is although necessary.

Flow-assisted basophil activation tests in immediate drug hypersensitivity: two decades of Antwerp experience

“…34,35 Actually, the major challenge in the diagnosis of IgE-mediated opiate hypersensitivity lies in the correct interpretation of positive skin test 34 and sIgE 6 results. In contrast, opiates such as morphine and diamorphine (heroin) seem not to trigger histamine release from human basophils.…”

“…Intracellular histamine content and its release are analysed flow cytometrically using the histaminase diamine oxidase (DAO) conjugated to LASER-excitable fluorochromes 13. For a description of the structure formula of pholcodine, codeine and morphine, see35 …”

Cannabis sativa: the unconventional “weed” allergen

“…Contaminants, additives, and inherent variability in the Table 2 Potential allergens of Cannabis sativa Delta-9-tetrahydrocannabinol (THC) 17,18 Nonspecific lipid transfer protein 7,29,30,38 (Can s 3) 31 Thaumatin-like protein 7 Ribulose-1,5-biphosphonate carboxylase/oxygenase (RuBisCO) 55 Oxygen-evolving enhancer protein 2 55 native allergen extracts might lead to irrelevant IgE binding components that can cloud diagnostic evaluation. 56 Some studies have demonstrated skin test reaction positivity in atopic controls and those without prior exposure or clinical symptoms, thus emphasizing that further study is needed to establish skin test sensitivity and specificity. 17,29 One study suggested promising sensitivity and specificity of skin tests (92.7% and 63.3% respectively) and serum IgE (88.1% and 88% respectively) used in its reviewed population.…”

Cannabis Allergy: What do We Know Anno 2015

“…First, respiratory reactions like rhinoconjunctivitis, asthma and palpebral angioedema have been described. These reactions predominantly occur when cannabis is consumed by smoking or vaporizing (Ebo et al 2013;Swerts et al 2014;Van Gasse et al 2014). Respiratory symptoms may also arise from passive exposure to cannabis smoke by proxy or inhalation of C. sativa pollen (Ebo et al 2013;Mayoral et al 2008;Prasad et al 2009;Singh and Shahi 2008;Stokes et al 2000;Torre et al 2007).…”