Mechanisms of activation of human mast cells and basophils by general anaesthetic drugs

Atracurium-induced anaphylaxis and angioedema: a case report

“…One is immune mediated -immunoglobulin E (IgE) dependent and the second one is associated with non-specific stimulation of mast cells (particularly with benzylisoquinolinium type NMBAs such as atracurium, mivacurium). 6,7 In the present case, the diagnosis of anaphylaxis with angioedema due to atracurium was made as the events occurred within seconds of giving injection atracurium, and the patient responded to injection adrenaline. The causality assessment was done, and association of event with atracurium was probable with both WHO causality assessment and Naranjo's scale (score of +6).…”

“…6 Anaphylactic reactions along with cutaneous manifestations are still rarer. The present case had cutaneous manifestations in the form of angioedema of the face apart from systemic manifestations of cardiovascular collapse and bronchospasm.…”

Anesthetic considerations in pediatric mastocytosis: a review

“…Studies of codeine, meperidine, and morphine indicate significantly more histamine release in vivo than with the newer semisynthetic opioids, fentanyl, sufentanil, and remifentanil [58,59,61,62]. A similar propensity for clinically significant histamine release has been observed for the older-generation muscle relaxants (e.g., mivacurium, tubocurarine, and atracurium) compared with newer products, for example vecuronium and cisatracurium, when administered in standard clinical doses [48,[63][64][65][66][67]. Furthermore, a drug's basic (versus acidic) character may affect mast cell activation, because positively-charged cations, for example narcotics and muscle relaxants, are believed to be involved in mast cell activation via non-receptor-mediated G-protein activation [9,11,65,66].…”

“…The reported incidence of anaphylaxis during anesthesia is approximately 1 case per 5,000-20,000 patients per year; this estimate may be increasing secondary to improved accounting measures [48][49][50]. Patients with mastocytosis experience both immune (IgE-related) and non-immune anaphylaxis, and the overall incidence of anaphylaxis in patients with mastocytosis has been reported to be higher than in the general population [1,16,35,51].…”

“…Sufentanil was first implicated as an initiator in 2001 after repeat exposure of an infant with bullous mastocytosis (see above) [45]. Propofol, a routinely-used intravenous induction agent which is increasingly recognized as a cause of anaphylaxis and has been shown to cause histamine release in vivo, is regarded as a safe alternative in the mastocytosis patient population [21,48,74,75]. Intravenous midazolam 0.2 mg/kg has been shown to induce histamine release in a susceptible adult patient population but has also been used safely in children with mastocytosis [15,27,76,77].…”