Immediate Allergic Hypersensitivity to Quinolones Associates with Neuromuscular Blocking Agent Sensitization

Rouzaire, Paul; Nosbaum, Audrey; Mullet, C.; Diot, N.; Dubost, R. Ferrenq; Bienvenu, F.; Guilloux, L.; Piriou, Vincent; Bienvenu, Jacques; Bérard, Frédéric

doi:10.1016/j.jaip.2013.02.007

Cited by 30 publications

(11 citation statements)

References 18 publications

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“…Identification of substituted (tertiary and quaternary) ammonium ions as the structures recognized on all NMBDs by the IgE antibodies in the sera of patients who experienced an anaphylactic reaction to a NMBD during anesthesia, has led on to intriguing questions and suggested explanations concerning the origin of the antibodies and to the increasing number of reports of IgE to ammonium groups on other drugs [5,32,34,36,[62][63][64][65]. Further studies should determine any additional clinical relevance or otherwise of these antibodies.…”

Section: Discussionmentioning

confidence: 99%

“…Recently it was claimed that immediate hypersensitivity to quinolones is frequently linked to NMBD sensitization [62] but this is likely to simply be a reflection of cross-reactivity of substituted ammonium groups on both NMBDs and quinolones detected by the ammonium group-reactive IgE antibodies present in the sera of patients allergic to NMBDs [63,64,65]. Clearly, questions remain concerning the involvement, detection and specificity of IgE antibodies to quinolones and the relevance of these antibodies detected in skin tests and immunoassays in both allergic and non-allergic subjects remains to be determined.…”

Section: Quinolonesmentioning

confidence: 99%

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IgE and Drug Allergy: Antibody Recognition of ‘Small’ Molecules of Widely Varying Structures and Activities

Baldo

2014

Antibodies

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Abstract:The variety of chemically diverse pharmacologically-active compounds administered to patients is large and seemingly forever growing, and, with every new drug released and administered, there is always the potential of an allergic reaction. The most commonly occurring allergic responses to drugs are the type I, or immediate hypersensitivity reactions mediated by IgE antibodies. These reactions may affect a single organ, such as the nasopharynx (allergic rhinitis), eyes (conjunctivitis), mucosa of mouth/throat/tongue (angioedema), bronchopulmonary tissue (asthma), gastrointestinal tract (gastroenteritis) and skin (urticaria, eczema), or multiple organs (anaphylaxis), causing symptoms ranging from minor itching and inflammation to death. It seems that almost every drug is capable of causing an immediate reaction and it is unusual to find a drug that has not provoked an anaphylactic response in at least one patient. These facts alone indicate the extraordinary breadth of recognition of IgE antibodies for drugs ranging from relatively simple structures, for example, aspirin, to complex molecules, such as the macrolide antibiotics composed of a large macrocyclic ring with attached deoxy sugars. This wide recognition profile is borne out at the molecular level by results of quantitative immunochemical studies where hapten inhibition investigations have identified structural determinants complementary to IgE antibodies in the sera of allergic subjects. Allergenic determinants have been identified on a variety of drugs including neuromuscular blockers, penicillins, cephalosporins, opioids, thiopentone, sulfonamides, trimethoprim, quinolones, chlorhexidine and the non-steroidal anti-inflammatory drug aspirin. It is already clear that IgE can distinguish fine structural differences on a wide variety of molecules, determinants OPEN ACCESSAntibodies 2014, 3 57 may be at least as small as an amino group or encompass the whole molecule, and individual drugs may demonstrate allergenic heterogeneity.

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Section: Discussionmentioning

confidence: 99%

Section: Quinolonesmentioning

confidence: 99%

IgE and Drug Allergy: Antibody Recognition of ‘Small’ Molecules of Widely Varying Structures and Activities

Baldo

2014

Antibodies

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“…Other drugs, such as opiates, and environmental chemicals also contain QA [2,3,4]. This shared epitope might in part explain the cross-sensitization between different NMBAs, as seen in most patients allergic to NMBAs, and the fact that a history of previous exposure to NMBAs is only found in fewer than 50% of patients adversely reacting to NMBAs during anesthesia [5,6].…”

Section: Introductionmentioning

confidence: 99%

Non-IgE-Dependent Hypersensitivity to Rocuronium Reversed by Sugammadex: Report of Three Cases and Hypothesis on the Underlying Mechanism

Spoerl

D''Incau

Roux‐Lombard

et al. 2016

Int Arch Allergy Immunol

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We present 3 cases of pseudoallergic (anaphylactoid) reactions to perioperatively administered rocuronium, which rapidly resolved after sugammadex injection. Allergological workup showed no evidence for immediate-type hypersensitivity to the drugs used for anesthesia, including rocuronium. However, rocuronium induced an irritative reaction in skin tests in all 3 patients and in 3 healthy individuals. This reaction was specifically suppressed by adding sugammadex at a 1:1 molecular proportion to rocuronium before the skin tests. This observation suggests that the patients suffered from a pseudoallergic reaction, and indicates that sugammadex might act via the inhibition of non-IgE mediated MRGPRX2 (Mas-related G-protein-coupled receptor member X2)-triggered mast cell degranulation induced by rocuronium.

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“…13 Se ha reportado alta prevalencia (53 %) de sensibilización al amonio cuaternario, el determinante alérgico de los agentes bloqueantes neuromusculares, en pacientes con hipersensibilidad alérgica a los antibióticos del grupo quinolonas. 14…”

Section: Fisiopatologíaunclassified

Reacciones adversas inmunitarias y no inmunitarias a fármacos de uso perioperatorio

González-Díaz

Arias-Cruz

Monge-Ortega

2019

RAM

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Las reacciones a medicamentos pueden ocurrir por mecanismos mediados o no por imunoglobulina E. La alergia a fármacos es un tipo de interacción adversa y comprende una gama de reacciones de hipersensibilidad mediadas por distintos mecanismos inmunológicos con diversas manifestaciones clínicas. Se estima una tasa anual de 3.2 casos fatales de anafilaxia asociados con los fármacos por cada 100 000 habitantes, que parece ser aproximadamente 10 veces mayor en los pacientes hospitalizados. La incidencia de reacciones anafilácticas perioperatorias se estima en uno de cada 10 000-20 000 procedimientos anestésicos. El diagnóstico se basa en una cuidadosa historia clínica y en el examen físico. En algunos casos pueden requerirse pruebas cutáneas, pruebas de retos progresivos y procedimientos de inducción de tolerancia al medicamento. En los pacientes hospitalizados y en el intervalo perioperatorio frecuentemente se emplean relajantes musculares, neurolépticos y morfinomiméticos, por lo que pueden presentarse respuestas adversas a estos fármacos. En esta revisión se hace énfasis en las reacciones alérgicas a los medicamentos y se abordan estrategias para su diagnóstico y manejo.

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Immediate Allergic Hypersensitivity to Quinolones Associates with Neuromuscular Blocking Agent Sensitization

Cited by 30 publications

References 18 publications

IgE and Drug Allergy: Antibody Recognition of ‘Small’ Molecules of Widely Varying Structures and Activities

IgE and Drug Allergy: Antibody Recognition of ‘Small’ Molecules of Widely Varying Structures and Activities

Non-IgE-Dependent Hypersensitivity to Rocuronium Reversed by Sugammadex: Report of Three Cases and Hypothesis on the Underlying Mechanism

Reacciones adversas inmunitarias y no inmunitarias a fármacos de uso perioperatorio

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