Anaphylaxis caused by γ-cyclodextrin in sugammadex

Hotta, Eri; Tamagawa‐Mineoka, Risa; Masuda, Koji; Taura, Maiko; Nakagawa, Yuka; Kanehisa, Fuminao; Tashima, Saki; Katoh, Norito

doi:10.1016/j.alit.2016.02.013

Cited by 16 publications

(12 citation statements)

References 9 publications

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“…The remaining 23 records were analyzed in-depth and their references explored. [ 9 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 ]…”

Section: Resultsmentioning

confidence: 99%

Sugammadex and anaphylaxis

Bora

Şahin

Özdoğan

2021

Journal of Anaesthesiology Clinical Pharmacology

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In this study, the published sugammadex-induced anaphylaxis reports were reviewed to determine similarities in their presentation during anesthesia. PubMed was searched for sugammadex-induced anaphylaxis without time limitation. Reports were evaluated if they were in English and met the criteria of anaphylaxis determined by the World Allergy Organization. Two independent reviewers extracted and assessed the data using predesigned data collection forms. In total, 23 suitable articles were found and 33 sugammadex-induced anaphylaxis cases were included in the study. The mean age was 43.09 years (from 3–89 years) and 17 (51.5%) of the patients were female. Considering all reported cases, the average onset time of anaphylaxis was 3.08 min, with a median of 3 min (range 1–8 min). The most common signs and symptoms were hypotension, tachycardia, erythema, and desaturation. Of the 20 patients who underwent confirmatory skin testing, 15 had a positive skin reaction for sugammadex. Epinephrine was not given when indicated in about 25% of cases. Sugammadex-induced anaphylaxis onset time was less than 5 min in 92.3% of all the reported cases. Rapid diagnosis and early recognition of signs and symptoms of anaphylaxis are essential for a favorable prognosis. Treatment needs to be started as soon as possible to ensure the best outcome for the patient.

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“…The remaining 23 records were analyzed in-depth and their references explored. [ 9 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 ]…”

Section: Resultsmentioning

confidence: 99%

Sugammadex and anaphylaxis

Bora

Şahin

Özdoğan

2021

Journal of Anaesthesiology Clinical Pharmacology

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“…Our patient had a positive reaction to both sugammadex and sugammadex-rocuronium complex, suggesting that both of sugammadex and sugammadex encapsulating rocuronium expressed possible antigenic epitope. Like the case of anaphylaxis to sugammadex showing that γ-cyclodextrin in sugammadex was the causative allergen by skin test [ 12 ], the unchanged part common to sugammadex and sugammadex-rocuronium complex might have acted as allergen. It is extremely rare for both sugammadex and sugammadex-rocuronium complex to be identified as allergens in one patient [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Anaphylaxis induced by sugammadex and sugammadex-rocuronium complex -a case report-

Choi

Han

Kwak

et al. 2020

Korean J Anesthesiol

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Background: In sugammadex-induced anaphylaxis, sugammadex and/or sugammadex-rocuronium complex have possible allergenic epitope. Case: We report a case of sugammadex-induced anaphylaxis during general anesthesia in a 60-year-old male undergoing orthopedic hand surgery, manifesting as profound hypotension and urticaria. The timing of onset was closely associated with sugammadex administration. The patient recovered after extensive therapy including fluid, epinephrine, other vasopressors, steroid, and antihistamine administration. By intradermal skin test which was done at four weeks after anaphylaxis, we confirmed positive reactions to both sugammadex and sugammadex-rocuronium complex. Conclusions: This is a rare case of sugammadex-induced anaphylaxis that both sugammadex and sugammadex-rocuronium complex were confirmed as allergenic epitopes.

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“…One possible mechanism for sugammadex-induced hypersensitivity or anaphylaxis is that sugammadex has gamma-cyclodextrin structures, which are also included in foods and daily-use goods (flavors, certain sensitive colors, fatsoluble vitamins, polyunsaturated fatty acids). 18,19 Another possible mechanism is that cyclodextrins may change the immunologic and allergenic behavior of the sugammadex-rocuronium complex. 20 In contrast, another study reported that sugammadex was useful for the management of rocuronium-induced anaphylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…The issue of whether sugammadex increases anaphylaxis during anesthesia has been under debate. One possible mechanism for sugammadex‐induced hypersensitivity or anaphylaxis is that sugammadex has gamma‐cyclodextrin structures, which are also included in foods and daily‐use goods (flavors, certain sensitive colors, fat‐soluble vitamins, polyunsaturated fatty acids) . Another possible mechanism is that cyclodextrins may change the immunologic and allergenic behavior of the sugammadex‐rocuronium complex .…”

Section: Discussionmentioning

confidence: 99%