Xylometazoline nasal drops induced anaphylaxis: An atypical perioperative complication

Haldar, Rudrashish; Bajwa, SukhminderJit Singh; Kaur, Jasleen

doi:10.4103/0970-9185.173331

Cited by 3 publications

(4 citation statements)

References 13 publications

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“…BAC is commonly used as an bactericidal preservative and is another common excipient associated with anaphylaxis. 17 Anaphylaxis was reported following administration of xylometazoline nasal drops containing BAC, 17 following administration of nebulised salbutamol containing BAC 18 and after insertion of a BAC-coated central venous cannula. 19 There has since been a call to remove BAC from all nebulised solutions.…”

Section: Discussionmentioning

confidence: 99%

Anaphylaxis to intravenous paracetamol containing povidone. A case report and narrative review of excipient allergy related to anaesthesia

Preuss

Goddard

Clarke

et al. 2020

Anaesth Intensive Care

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Investigation of intraoperative anaphylaxis includes the exclusion of potential trigger agents the individual was exposed to within a plausible interval preceding the reaction. Occasionally, none of these agents will test positive. In this situation it is important to consider that excipients may be responsible for anaphylaxis, that the dilutions prepared to test the medication may not contain an appropriate concentration of the excipient to induce a positive skin reaction, or if an alternative formulation of the medication is tested, it may not contain the culprit excipient. This case describes a patient, who previously experienced an anaphylactic reaction to Betadine® (Sanofi-Aventis Australia Pty Ltd, North Ryde BC, NSW) experiencing anaphylaxis in the recovery period after general anaesthesia where Betadine was avoided. The recently administered therapeutics were excluded by skin testing, however further investigation determined that a povidone-containing formulation of paracetamol had been administered. Skin testing with povidone-containing paracetamol resulted in a positive reaction in the patient, but not in a volunteer control. Pharmaceutical excipients are added to medications to increase absorption, shelf-life and efficacy. Different brands of the same drug may contain different excipients. When testing for anaphylaxis with such compounds one must be sure the dilution is appropriate for both the parent compound and the excipient to ensure the accuracy of skin-prick and intradermal testing. This case demonstrates the potential for excipients to cause severe allergy and the importance of detailed history pertaining to previous allergic episodes as even the most unlikely of medications can potentially result in anaphylaxis due to excipients.

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Section: Discussionmentioning

confidence: 99%

Anaphylaxis to intravenous paracetamol containing povidone. A case report and narrative review of excipient allergy related to anaesthesia

Preuss

Goddard

Clarke

et al. 2020

Anaesth Intensive Care

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“…describe the case of a 23-year-old patient referred for adenotomy who developed severe anaphylactic shock after applying 2 drops to each nostril of a commercially available xylometazoline preparation to reduce nasal mucosal congestion. [20] The patient required prompt intervention to stabilize baseline parameters as there was tachycardia (135 beats/min), hypotension (96/56 mmHg), and a decrease in oxygen saturation (92% for room air). Lung auscultation examination indicated bilateral wheezing.…”

Section: Adverse Side Effects -A Review Of Clinical Casesmentioning

confidence: 99%

“…[20] Xylometazoline hydrochloride (0.1%) as an active ingredient and benzalkonium chloride (BAC) (0.011%) having antiseptic properties, which is known for adverse effects such as anaphylaxis and angioedema, are suspected to be the main cause of the above mentioned symptoms. [20] After observing the aforementioned symptoms and correlating them with a positive skin test, as well as elevated serum tryptase levels-a marker of immune activation-it was concluded that the incident was an anaphylactic reaction to a xylometazoline-containing preparation. [20] Because of the poorly formed blood-brain barrier, neonates and infants are more sensitive to the central side effects of sympathicomimetics.…”

Section: Adverse Side Effects -A Review Of Clinical Casesmentioning

confidence: 99%

“…[20] After observing the aforementioned symptoms and correlating them with a positive skin test, as well as elevated serum tryptase levels-a marker of immune activation-it was concluded that the incident was an anaphylactic reaction to a xylometazoline-containing preparation. [20] Because of the poorly formed blood-brain barrier, neonates and infants are more sensitive to the central side effects of sympathicomimetics. Inadvertent use of these drugs in children under 6 years of age is common and can cause adverse effects, including life-threatening ones.…”

Section: Adverse Side Effects -A Review Of Clinical Casesmentioning

confidence: 99%

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Xylometazoline and oxymetazoline - unusual effects of everyday drugs (literature review)

Klas

Kluz

Piwowar

2021

J Educ Health Sport

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The aim of the study is to systematize the knowledge about xylometazoline and oxymetazoline - commonly used nasal sprays with sympathicomimetic effect, mainly directly on α-adrenergic receptors [1]. A review of recent reports on possible side effects and new therapeutic options will be presented. Results: Over several years, reports have been published regarding descriptions of unusual cases of side effects, such as angina attack [4], a case of respiratory failure in a newborn [5], ischemic stroke [6], or anaphylactic reaction during routine surgery. In experiments using rats, on the other hand, it has been shown that these substances can also cause increased inflammation of the lower respiratory tract [7], as well as numerous ophthalmic problems [8]. Recent reports also suggest new uses for xylometazoline and oxymetazoline. In combination with lidocaine, an intranasal solution of xylometazoline has shown efficacy in the anesthesia of maxillary teeth in patients with minor carious lesions [9], and a beneficial therapeutic combination of oxymetazoline and dye laser (PDL) has also been reported for the treatment of rosacea, among others [10]. Conclusions: Although imidazoline derivatives were admitted to the drug list decades ago, still their pharmacological potential has not been fully exploited. Finding applications of these drugs in dermatology and dentistry may not only improve the efficacy and comfort of treatment, but also significantly reduce the costs of the whole therapy. The aforementioned reports on the side effects of xylometazoline and oxymetazoline should not be forgotten. It is possible that the presented examples will increase awareness to use these drugs with more respect, according to the recommendations on the leaflet.

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Xylometazoline

2017

Reactions Weekly

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Xylometazoline nasal drops induced anaphylaxis: An atypical perioperative complication

Cited by 3 publications

References 13 publications

Anaphylaxis to intravenous paracetamol containing povidone. A case report and narrative review of excipient allergy related to anaesthesia

Anaphylaxis to intravenous paracetamol containing povidone. A case report and narrative review of excipient allergy related to anaesthesia

Xylometazoline and oxymetazoline - unusual effects of everyday drugs (literature review)

Xylometazoline

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