Anaphylaxis caused by tetrazepam without cross-reactivity with other benzodiazepines

Martinez-Tadeo, Juan Antonio; Perez-Rodriguez, Eva; Hernández-Santana, Guacimara; García-Robaina, José Carlos; Torre‐Morín, F. De La

doi:10.1016/j.anai.2012.01.019

Cited by 5 publications

(5 citation statements)

References 4 publications

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“…On the other hand, the patient had a history of taking brotizolam, a benzodiazepine, but was not allergic to it. Regarding cross-reactivity among benzodiazepines, some reports showed cross-reactivity among benzodiazepines [18,19], while others did not [20]. To date, cross-reactivity among benzodiazepines is poorly understood.…”

Section: Discussionmentioning

confidence: 99%

Remimazolam anaphylaxis in a patient not allergic to brotizolam: a case report and literature review

Nakai,

Kako,

Ota

et al. 2024

BMC Anesthesiol

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Background Remimazolam is a recently developed, ultrashort-acting benzodiazepine that is used as a general anesthetic. Some cases of remimazolam anaphylaxis have been reported, but its characteristics are not fully understood. We present an interesting case report and review of the literature to better understand remimazolam anaphylaxis. Case presentation A 75-year-old man scheduled for robot-assisted gastrectomy was administered remimazolam for the induction of general anesthesia. After intubation, low end-expiratory CO2, high airway pressure and concurrent circulatory collapse were observed. Bronchoscopy revealed marked tracheal and bronchial edema, which we diagnosed as anaphylaxis. The patient suffered cardiac arrest after bronchoscopy but recovered immediately with intravenous adrenaline administration and chest compressions. We performed skin prick tests for the drugs used during induction except for remimazolam, considering the high risk of systemic adverse reactions to remimazolam. We diagnosed remimazolam anaphylaxis because the skin prick test results for the other drugs used during anesthesia were negative, and these drugs could have been used without allergic reactions during the subsequent surgery. Furthermore, this patient had experienced severe anaphylactic-like reactions when he underwent cardiac surgery a year earlier, in which midazolam had been used, but it was not thought to be the allergen at that time. Based on these findings, cross-reactivity to remimazolam and midazolam was suspected. However, the patient had previously received another benzodiazepine, brotizolam, to which he was not allergic, suggesting that cross-reactivity of remimazolam may vary among benzodiazepines. In this article, we reviewed the 11 cases of remimazolam anaphylaxis that have been described in the literature. Conclusions Remimazolam is an ultrashort-acting sedative; however, it can cause life-threatening anaphylaxis. In addition, its cross-reactivity with other benzodiazepines is not fully understood. To increase the safety of this drug, further research and more experience in its use are needed.

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Section: Discussionmentioning

confidence: 99%

Remimazolam anaphylaxis in a patient not allergic to brotizolam: a case report and literature review

Nakai,

Kako,

Ota

et al. 2024

BMC Anesthesiol

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“…S1 1 , diazepam has great structural homology with tetrazepam, deviating only at R4 substitution (aromatic ring (T) and cyclohexene ring (D)). Although the chemical structure of these 2 muscle relaxants is very similar, with the exception of one report, all other reports failed to demonstrate cross-reactivity (3)(4)(5).…”

Section: Short Communicationmentioning

confidence: 90%

Tetrazepam Allergy: A Case Series of Cutaneous Adverse Events

Huseynov¹,

Wirtz²,

Hunzelmann³

2016

Acta Derm Venerol

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“…The symptoms of benzodiazepine overdose include drowsiness, slurred speech, ataxia, horizontal gaze nystagmus, hypotension, coma, respiratory depression and cardiorespiratory arrest88. Some patients can have severe allergies such as anaphylaxis and angioedema8990. Flumazenil is indicated for reversing the sedative effect of benzodiazepines and for treatment in a benzodiazepine overdose91.…”

Section: Central Nervous System (Cns) Depressantsmentioning

confidence: 99%

Illicit drugs: Effects on eye

2019

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There is a myriad of changes that can be produced in the eye by toxic drugs ranging from mild/no symptoms to severe loss of vision from endophthalmitis. The routes of administration include oral ingestion, smoking, nasal inhalation, intravenous injection, topical application or application to other mucosal surfaces. It is important to recognize certain clinical signs and symptoms in the eye produced by these toxins. This article describes in brief some of the ocular effects of commonly abused drugs. For identification of a particular poisoning, in addition to the clinical presentation, pulse, blood pressure, respiration and body temperature, pupillary size, pupillary reaction to light, ocular convergence and nystagmus can be useful indicators of the type of drug the patient is exposed to. Unmasking these features help the clinician in an early and accurate diagnosis of the offending drug as well as timely management.

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Anaphylaxis caused by tetrazepam without cross-reactivity with other benzodiazepines

Cited by 5 publications

References 4 publications

Remimazolam anaphylaxis in a patient not allergic to brotizolam: a case report and literature review

Remimazolam anaphylaxis in a patient not allergic to brotizolam: a case report and literature review

Tetrazepam Allergy: A Case Series of Cutaneous Adverse Events

Illicit drugs: Effects on eye

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