Rapid Pre-operative Immunotherapy in a Patient Allergic to Muscle Relaxants

H, Thomas; Eledjam, J.J.; Macheboeuf, M; Athis, F. d'; Mareš, Petr; Bousquet, Jean

doi:10.1097/00132586-199002000-00023

Cited by 5 publications

(4 citation statements)

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“…Choline and tiemonium were initially used; unfortunately clinical tolerance of the highest doses was poor. As a result, the concentrations obtained were too low to be effective [55,56]. Recently, Moneret-Vautrin et al [57] demonstrated inhibition of skin mast-cell reactivity to muscle relaxants by mixing them with the monovalent haptens cytidylcholine and ethamsylate.…”

Section: Preventionmentioning

confidence: 99%

Adverse reactions to neuromuscular blocking agents

Mertès¹,

Laxenaire²

2004

Curr Allergy Asthma Rep

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Neuromuscular blocking agents (NMBAs) play a predominant role in the incidence of severe adverse reactions occurring during anesthesia. Most hypersensitivity reactions are of immunologic origin (IgE-mediated) or are related to direct stimulation of histamine release. The incidence of IgE-mediated hypersensitivity or anaphylaxis is estimated between 1 in 10,000 and 1 in 20,000 anesthesias, and NMBAs represent the most frequently involved substances, with a range of 50% to 70%. Any suspected anaphylactic reaction must be extensively investigated using combined perioperative and postoperative testing. Because of the frequent cross-reactivity observed with muscle relaxants, every available NMBA should be tested. This should help provide documented advice for future administration of anesthesia. There is no demonstrated evidence for systematic preoperative screening in the general population at this time. Other well-known adverse effects have been described, such as the succinylcholine-triggered cytotoxic effects on muscle cells, but these are responsible for characteristic clinical symptoms, which are usually easy to distinguish from anaphylactic reactions

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Section: Preventionmentioning

confidence: 99%

Adverse reactions to neuromuscular blocking agents

Mertès¹,

Laxenaire²

2004

Curr Allergy Asthma Rep

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“…Choline and tiemonium were first used, but the clinical tolerance or the admissible dose were considered too low [11,12], Cytidylchoiine and ethamsylate are injec table drugs currently used in internal medicine in the same dose range as that used in this study. No undesirable system ic effects have been recorded so far.…”

Section: Discussionmentioning

confidence: 99%

Prevention by Monovalent Haptens of IgE-Dependent Leucocyte Histamine Release to Muscle Relaxants

Moneret-Vautrin¹,

Kanny²,

Guéant³

et al. 1995

Int Arch Allergy Immunol

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The cross-reactivity between muscle relaxants (MRs) is a risk for inducing anaphylaxis in sensitized patients. The preventive use of monovalent haptens (MHs) was studied in 21 cases. Inhibition of the skin reactivity by mixing MRs and MHs was observed, as was the inhibition of leucocyte histamine release to MRs, up to 3 h after infusion of MHs. These results argue for the use of such a protocol, if surgery requires the use of a MR in patients at risk for anaphylaxis.

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“…It has been shown to be useful in anticonvulsants, antituberculosis, 35 chemotherapy, antimicrobials, 36 NSAIDs, 37 and immunotherapy. 34 The role of drug desensitization has been described in perioperative patients; 38,39 however, its multiple drug hypersensitivity syndrome Sany A, et al…”

Section: Role Of Drug Desensitizationmentioning

confidence: 99%

Perioperative management of a patient with multiple drug hypersensitivity syndrome: Anesthesia perspective

Sany

Leow

Ghaffar

et al. 2020

APIC

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Patients with multiple drug hypersensitivity often pose significant challenge during surgery because of the greater risk of developing anaphylactic shock that could be fatal. The use of novel pharmaceutical agents such as anesthetic drugs and medical devices made from a wide range of chemicals and materials with unknown antigenicity potentially predisposes this subset of patients to hypersensitivity reactions in the perioperative period. The authors encountered a 20-year-old patient with a history of multiple drug hypersensitivities, who had been diagnosed with a huge ovarian tumor. She underwent surgery successfully but faced a rather difficult recovery. Herein, we discuss the management of unexpected perioperative outcomes with the support of literature review. This article also highlights the use of drug provocation tests and the necessary precautions to be taken in the absence of standardized preoperative guidelines for patients with multiple drug hypersensitivity syndrome undergoing major surgical procedures. Key words: Multiple hypersensitivity; Perioperative; Anesthesia; Suture; Drug provocation test Citation: Sany S, Leow VM, Ghaffar ZA, Lim JA, Chong SE. Perioperative management of a patient with multiple drug hypersensitivity syndrome: Anesthesia perspective. Anaesth. pain intensive care 2020;24(6):__ Received: 10 August 202-, Reviewed: 29 October, 1 November 2020, Accepted: 1 November 2020

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Rapid Pre-operative Immunotherapy in a Patient Allergic to Muscle Relaxants

Cited by 5 publications

References 0 publications

Adverse reactions to neuromuscular blocking agents

Adverse reactions to neuromuscular blocking agents

Prevention by Monovalent Haptens of IgE-Dependent Leucocyte Histamine Release to Muscle Relaxants

Perioperative management of a patient with multiple drug hypersensitivity syndrome: Anesthesia perspective

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