Histamine release and hepatic elimination of histamine following abdominal surgery

Footshock-induced rise of rat blood histamine depends upon the activation of postganglionic sympathetic neurons

We have previously shown the existence of a novel peripheral reflex inhibitorily modulating the vas deferens sympathetic activity. An interaction between noradrenergic and histamine-containing neurons is involved in this reflex. As an overall mechanism of sympathetic autoregulation, we found that enhanced sympathetic activity in the rat during the stress induced by brief inescapable footshocks caused a marked rise of blood histamine that was seemingly dependent upon sympathetic activity. This rise was prevented by either previous ganglionic blockade with hexamethonium or chronic guanethidine-induced sympathectomy. Previous adrenal demedullation did not impair this rise. Thus, it appears that only the sympathetic postganglionic neuron, interacting with a histamine-containing neuron, is involved in the rise of blood histamine induced by footshocks.

Perioperative uses of histamine antagonists

Histamine release and adverse pseudoallergic/allergic reactions during the perioperative period occur frequently. The incidence of such reactions is 20%-30% for all grades of severity, 1%-5% for systemic reactions, and 0.1%-0.5% for life-threatening reactions. They can be elicited by all commonly used anesthetic agents and by surgical interventions. Both the incidence and severity can be reduced by the use of combined prophylaxis with H1- + H2-receptor antagonists. The authors recommend that this prophylaxis be given to the following groups of patients: those with a history of adverse reactions or history of allergy, patients undergoing surgery with a high risk of histamine release, elderly patients, and those with poor physical status due to underlying systemic diseases. These indications have been developed by heuristic medical decision-making, including a decision tree.

Histamine-releasing properties of Polysorbate 80 in vitro and in vivo: correlation with its hypotensive action in the dog

The solvent of commercial amiodarone (Polysorbate 80) has been reported to produce haemodynamic responses in humans and in dogs similar to those produced by histamine infusion. We therefore evaluated the correlation between hypotension induced by the solvent of amiodarone and its histamine-releasing properties in the awake dog. The solvent of amiodarone administered to a dog, over 5 min in a dose of 10 mg/kg of Polysorbate 80, produced severe hypotension after the first administration; the second injection (24 h later) caused fewer hypotensive effects. Histamine release in the peripheral tissues was demonstrated by a marked increase in plasma histamine concentrations, with the maximum value 10 min after the solvent administration. H1- and H2-receptor blockade with mepyramine (5 mg/kg) and cimetidine (10 mg/kg) significantly reduced the cardiovascular effects of the solvent. Isolated peritoneal mast cells from rats also released histamine in response to Polysorbate 80. These studies show that Polysorbate 80 releases histamine both in vitro and in isolated mast cells from rats and in vivo in the dog, and that the plasma concentrations are correlated with the haemodynamic responses.

Predominance of histamine H1 receptors on liver plasma membrane

We quantitatively determined the receptors for histamine H1, histamine H2, alpha- and beta-adrenergic, prostaglandin E2 and F2 alpha in liver plasma membranes. The number of the receptors was the greatest in histamine H1 receptors (4740 +/- 750 fmol/mg protein) and the second in alpha-adrenergic receptors (965 +/- 16). Although relatively small numbers of the receptors were observed for histamine H2 (116 +/- 11) and prostaglandin E2 (38.0 +/- 8.9), we could not determine the number and affinity of beta-adrenergic and prostaglandin F2 alpha receptors. In contrast to the number of receptors, there was not significant difference in the affinities of receptors for histamine H1, histamine H2, alpha-adrenergic hormone and prostaglandin E2. These results suggest that histamine and its receptor play some role in liver function.

[Histamine liberation induced by anesthetics or their solvents: specific or non-specific?]

Histamine release is a frequent event in the perioperative period. The reasons for its occurrence are complex; they include pseudoallergic and allergic phenomena--and probably a mixture of both. Some drugs and solvents seem to modulate histamine release induced by other drugs. Thus the terms "specific and nonspecific" or "selective and nonselective" histamine release which have their well appreciated place in experimental immunology and pharmacology should be avoided in describing histamine release responses in clinical conditions. The clinical relevance of histamine release in the perioperative period is considerable and can be compared with that of perioperative thrombosis and thromboembolism. Far too many drugs and anaesthetic and surgical procedures give increased plasma histamine levels; premedication with H1- + H2-histamine receptor antagonists is therefore recommended in patients who have a history of hypersensitivity reactions to intravenous agents; a history of atopy, who are to be given the same drug a few days later, undergo surgery with a high risk of histamine release, are more than 70 years old or are poor risk patients with perioperative cardiac, respiratory or liver failure and shock.