Anaphylaxis caused by muscle relaxant (eperisone hydrochloride)

Kim, Sung Hyun; Lee, Jaechun; Kim, Suhee; Kim, Hyun Woo; Kim, Young Uck; Lim, Younghyup; Moon, Shinhang; Moon, Jae-cheol; Heo, Dahee

doi:10.4168/aard.2013.1.2.172

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…SPT and BAT were negative in this study. In previous reports, SPT yielded negative reactions,111516 and only 1 case of positive intradermal test reaction has been reported 15. However, this study did not indicate a non-irritating concentration of intradermal test.…”

Section: Discussioncontrasting

confidence: 71%

Eperisone-Induced Anaphylaxis: Pharmacovigilance Data and Results of Allergy Testing

Park

Lee

Yuk

et al. 2019

Allergy Asthma Immunol Res

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Purpose Eperisone is an oral muscle relaxant used in musculoskeletal disorders causing muscle spasm and pain. For more effective pain control, eperisone is usually prescribed together with nonsteroidal anti-inflammatory drugs (NSAIDs). As such, eperisone may have been overlooked as the cause of anaphylaxis compared with NSAIDs. This study aimed to analyze the adverse drug reaction (ADR) reported in Korea and suggest an appropriate diagnostic approach for eperisone-induced anaphylaxis. Methods We reviewed eperisone-related pharmacovigilance data (Korea Institute of Drug Safety-Korea Adverse Event Reporting System [KIDS-KAERS]) reported in Korea from 2010 to 2015. ADRs with causal relationship were selected. Clinical manifestations, severity, outcomes, and re-exposure information were analyzed. For further investigation, 7-year ADR data reported in a single center were also reviewed. Oral provocation test (OPT), skin prick test (SPT) and basophil activation test (BAT) were performed in this center. Results During the study period, 207 patients had adverse reactions to eperisone. The most common ADRs were cutaneous hypersensitive reactions (30.4%) such as urticaria, itchiness or angioedema. Fifth common reported ADR was anaphylaxis. There were 35 patients with anaphylaxis, comprising 16.9% of the eperisone-related ADRs. In the single center study, there were 11 patients with eperisone-induced anaphylaxis. All the patients underwent OPT and all the provoked patients showed a positive reaction. Four of the 11 patients with anaphylaxis also underwent SPT and BAT, which were all negative. Conclusions Incidence of eperisone-induced anaphylaxis calculated from the KIDS-KAERS database was 0.001%. Eperisone can cause hypersensitive reactions, including anaphylaxis, possibly by inducing non-immunoglobulin E-mediated immediate hypersensitivity.

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Section: Discussioncontrasting

confidence: 71%

Eperisone-Induced Anaphylaxis: Pharmacovigilance Data and Results of Allergy Testing

Park

Lee

Yuk

et al. 2019

Allergy Asthma Immunol Res

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“…6 In another study, IDTs for eperisone were performed in 2 patients, and one of them, who presented with moderate anaphylaxis, showed a positive response to the IDT. 7 To summarize, IDTs with eperisone were done in a few cases reports, 3,5,7 and only 2 cases 5,7 showed positive results among which one positive result was shown in severe anaphylaxis patient. Our study included nine IDT results, which is small but yet the largest to include in a single study.…”

Section: Discussionmentioning

confidence: 99%

“…4 In one case of eperisone-induced severe anaphylaxis who presented with hypotension and hypoxia, IDT with eperisone showed a positive result. 5 In a case series, there were 3 cases of eperisone-induced immediate-type hypersensitivity confirmed by OPTs, but IDTs urticaria and were not performed. Among the 3 cases, 2 patients experienced dyspnea, and one patient experienced urticaria and hypotension.…”

Section: Discussionmentioning

confidence: 99%

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Clinical characteristics of eperisone-induced immediate-type hypersensitivity

Shin

Yoon

Lee

et al. 2020

Asian Pac J Allergy Immunol

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Background: Eperisone is a commonly prescribed oral muscle relaxant, but few studies have been conducted of eperisone-induced hypersensitivity reactions. Objective:The purpose of this study was to investigate the clinical manifestations of eperisone-induced immediate-type hypersensitivity, and to evaluate the role of an intradermal test (IDT) in eperisone-induced anaphylaxis.Methods: This study was based on a retrospective review of medical records from 23 patients diagnosed as eperisone-induced immediate-type hypersensitivity with certain or probable causality. Intradermal tests were performed with a sterile 10 mg/mL eperisone solution.Results: Immediate-type hypersensitivity reactions to eperisone occurred within 15 minutes in 8.7%, within 30 minutes in 52.2%, and within 60 minutes in 82.6% of the patients, cumulatively. All patients showed cutaneous symptoms. Gastrointestinal symptoms were the second-most frequent (65.2%), respiratory symptoms (56.5%) followed, and cardiovascular symptoms were the least (39.1%). Nine (39.1%) patients were categorized as severe anaphylaxis. The mean onset time of severe anaphylaxis was 28.89 minutes, which was significantly shorter than non-severe anaphylaxis (p = 0.011). Five patients among the severe anaphylaxis group were evaluated with IDT, and all showed positive results. In contrast, all of the four patients who have done IDT among the moderate anaphylaxis group showed negative results. There was a significant relationship between severe anaphylaxis and positive IDT results (p = 0.008).Conclusions: Eperisone-induced immediate-type hypersensitivity is not uncommon in Korea, and the IDT could be a useful and safe diagnostic tool, especially in severe anaphylaxis.

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“…We identified 22 studies (18 studies reporting on 203 adults and four studies reporting on 74 children) on DPTs that were mostly performed as single-arm open-label tests for identifying culprit drugs [19,20,26,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]. DPTs in adults were performed with analgesics, antimicrobials, gastrointestinal medications, muscle relaxants, antitussives, H1 receptor antagonists, and corticosteroids.…”

Section: Dpts For the Diagnosis Of Drug Hypersensitivitymentioning

confidence: 99%