1
|
Abdelshafi NA, Darwish HW, Alanazi AS, Naguib IA, Elkhouly HH, Khodary NS, Mohamed EH. Voltammetric analysis of pholcodine on graphene-modified GNPs/PTs with green assessment. BMC Chem 2024; 18:48. [PMID: 38449002 PMCID: PMC10919016 DOI: 10.1186/s13065-024-01146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/19/2024] [Indexed: 03/08/2024] Open
Abstract
Pholcodine, an anti-tussive medication widely used as an over-the-counter, OTC drug, has recently faced restrictions in several countries. This paper presents a sensitive electrochemical approach for pholcodine detection. The electrochemical method involved fabricating a graphene nanoplatelets electrode, incorporating polythiophene nanospheres polymer to promote electron transfer and increase the activated surface area. Characterization of the fabricated electrode was performed using transmission electron microscopy, ATR-Fourier-transform infrared spectroscopy, X-ray crystallography, X-ray photoelectron spectroscopy, and electrochemical impedance spectroscopy. The electrochemical behavior of pholcodine with the fabricated electrode was investigated using cyclic voltammetry, chronoamperometry, square wave voltammetry (SWV), and differential pulse voltammetry (DPV). The developed electrode led to a linear response for pholcodine ranging from 10 to 45 mg/L with detection limits of 1.41 and 1.51 mg/mL for SWV and DPV, respectively and quantification limits of 4.27 and 4.57 mg/L for SWV and DPV, respectively. The proposed method has accurately recovered pholcodine in spiked serum samples with a recovery percentage ranging from 1.2 to 2.9%. The optimized method is found to be accurate, precise, and robust by applying validation parameters provided by International Council for Harmonization. Two green metrics were computed to assess the method's greenness, the findings showed that the developed method is environmentally friendly with minimum sample preparation steps.
Collapse
Affiliation(s)
- Nahla A Abdelshafi
- Department of Pharmaceutical Analytical Chemistry, School of Pharmacy, Badr University in Cairo, Badr City, Cairo, 11829, Egypt.
| | - Hany W Darwish
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, 11451, Riyadh, Saudi Arabia
| | - Ashwag S Alanazi
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, 11671, Riyadh, Saudi Arabia
| | - Ibrahim A Naguib
- Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, P.O. Box 11099, 21944, Taif, Saudi Arabia
| | - Hadeer H Elkhouly
- School of Pharmacy, Badr University in Cairo, Badr City, Cairo, 11829, Egypt
| | - Nehal S Khodary
- School of Pharmacy, Badr University in Cairo, Badr City, Cairo, 11829, Egypt
| | - Ekram H Mohamed
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, The British University in Egypt, El Sherouk City, Cairo, 11837, Egypt
| |
Collapse
|
2
|
Roshdy A, Salam RA, Hadad G, Belal F, Elmansi H. Fast concurrent determination of guaifenesin and pholcodine in formulations and spiked plasma using first derivative synchronous spectrofluorimetric approach. LUMINESCENCE 2024; 39:e4660. [PMID: 38286595 DOI: 10.1002/bio.4660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/25/2023] [Accepted: 12/05/2023] [Indexed: 01/31/2024]
Abstract
Guaifenesin and pholcodine are frequently co-formulated in certain dosage forms. A new fast first derivative synchronous spectrofluorometric method has been used for their simultaneous analysis in mixtures. Here, first derivative synchronous spectrofluorometry enabled the successful simultaneous estimation of guaifenesin at 283 nm and pholcodine at 275 nm using a wavelength difference (Δλ) of 40 nm. The method was fully validated following International Council of Harmonization guidelines. For guaifenesin and pholcodine, linearity was determined within the corresponding ranges of 0.05-0.30 and 0.10-6.0 μg/ml. The two drugs were effectively analyzed using the developed approach in their respective formulations, and the results showed good agreement with those attained using reference methods. The method demonstrated excellent sensitivity, with detection limits down to 0.007 and 0.030 μg/ml and quantitation limits of 0.020 and 0.010 μg/ml for guaifenesin and pholcodine, respectively. Therefore, the procedure was successful in determining these drugs simultaneously in vitro in spiked plasma samples and syrup dosage form. The developed methodology also offered an environmentally friendly advantage by utilizing water as the optimal diluting solvent throughout the whole work. Different greenness approaches were investigated to ensure the method's ecofriendly properties.
Collapse
Affiliation(s)
- Aya Roshdy
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Horus University-Egypt, New Damietta, Egypt
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| | - Randa Abdel Salam
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| | - Ghada Hadad
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| | - Fathalla Belal
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - Heba Elmansi
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| |
Collapse
|
3
|
Au EYL, Mak HWF, Yeung MHY, Chiang V, Lam K, Wong JCY, Yeung HHF, Chan EYT, Lau CS, Li PH. Ten-year outcomes of Perioperative Anaphylaxis Workup Study in Hong Kong (PAWS-HK): Performance of diagnostic modalities. Ann Allergy Asthma Immunol 2023:S1081-1206(23)00125-4. [PMID: 36842494 DOI: 10.1016/j.anai.2023.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Studies on perioperative anaphylaxis (PA) in Asia are lacking. Furthermore, allergy workup for PA has largely been limited to the "silver standard" of skin tests (ST). Using in vitro tests as an adjunct to ST may improve and overcome these diagnostic challenges. OBJECTIVE To evaluate the clinical characteristics and diagnostic tests of patients with suspected PA through the Perioperative Anaphylaxis Workup Study in Hong Kong cohort. METHODS Patients with a diagnosis of PA over a 10-year period were recruited into the Perioperative Anaphylaxis Workup Study in Hong Kong. We reviewed the medical records, tryptase elevation, and diagnostic tests including ST, specific immunoglobulin E, and basophil activation tests (BAT). RESULTS In 151 patients with PA, diagnosis was reached in three-fourths of the cases (113/151, 74.8%). The most common culprits identified were neuromuscular blocking agents (25.8%), β lactams (17.2%) and chlorhexidine (13.9%). Severe anaphylaxis was associated with female sex, older age, elevated acute tryptase levels, and more cardiovascular manifestations during induction. Skin tests remained the most sensitive diagnostic modality overall (66.2%). BAT showed better performance for chlorhexidine and gelofusine anaphylaxis, with sensitivity of 80.0% and 79.6%, respectively. Specific Immunoglobulin E indicated even higher sensitivity (95.2%) than did ST (85.0%) and BAT (80.0%) for chlorhexidine anaphylaxis but performed poorly for other drugs. CONCLUSION Neuromuscular blocking agents remain the most common culprit in PA. There was a higher prevalence of gelofusine anaphylaxis in our cohort than was seen in the literature. Skin tests remain the most sensitive testing modality. In vitro tests for chlorhexidine and gelofusine showed promising results, but more studies to further elucidate its use are warranted.
Collapse
Affiliation(s)
- Elaine Y L Au
- Division of Clinical Immunology, Department of Pathology Queen Mary Hospital, Hong Kong
| | - Hugo W F Mak
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Maegan H Y Yeung
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Valerie Chiang
- Division of Clinical Immunology, Department of Pathology Queen Mary Hospital, Hong Kong
| | - Ki Lam
- Division of Clinical Immunology, Department of Pathology Queen Mary Hospital, Hong Kong
| | - Jane C Y Wong
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Heather H F Yeung
- Division of Clinical Immunology, Department of Pathology Queen Mary Hospital, Hong Kong
| | - Eric Y T Chan
- Division of Clinical Immunology, Department of Pathology Queen Mary Hospital, Hong Kong
| | - Chak-Sing Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Philip H Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
| |
Collapse
|
4
|
Kosciuczuk U, Knapp P. What do we know about perioperative hypersensitivity reactions and what can we do to improve perioperative safety? Ann Med 2021; 53:1772-1778. [PMID: 34632895 PMCID: PMC8510593 DOI: 10.1080/07853890.2021.1976818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/31/2021] [Indexed: 11/05/2022] Open
Abstract
Hypersensitivity reactions are an important aspect of perioperative care and are a crucial interdisciplinary issue in anaesthesiological practice, as well as allergological and laboratory diagnostics. This phenomenon was observed as early as the 1980s and 1990s in Western European countries, and knowledge on this subject has grown significantly over time. Although hypersensitivity reactions are not frequent events (the incidence of perioperative hypersensitivity reactions ranges from 1:386 to 1:13 000 procedures, with higher frequency - 1 per 6500 general anaesthesias with neuromuscular blocking agents administrations), their courses are unfortunately serious and life-threatening. It should also be noted that there is no information regarding the occurrence of perioperative hypersensitivity reactions in many countries. Hence, global assessment of the problem is underestimated. The primary source of actual knowledge comes from epidemiological studies, which indicate an increasing frequency of hypersensitivity reaction occurrence and changes in aetiological factors. The first report from France (1984 to 1989) described two main causes - neuromuscular blocking agents and hypnotic agents. The following years confirmed an increase in perioperative hypersensitivity reactions associated with latex and antibiotics. The most recent data from the National Audit Project 6 indicated increased participation of antibiotics, chlorhexidine, and contrast agents. The results of epidemiological analyses are the basis of medical management guidelines and practice modification. Thanks to the activity of many organisations monitoring the intensity and nature of perioperative hypersensitivity reactions, guidelines for diagnostics and management have been developed. This article presents the results of numerous studies, including the first and the most recent, from various geographical regions. The clinical significance, pathogenesis mechanisms are also discussed. This publication also presents important directions for further scientific and epidemiological research on perioperative hypersensitivity reactions.Key messagesThe incidence of perioperative hypersensitivity reactions ranges from 1:386 to 1:13 000 procedures, with higher frequency - 1 per 6500 general anaesthesias with neuromuscular blocking agents administrations.Reactions may occur during the first episode of anaesthesia, most frequently in the induction of general anaesthesia, and much less frequently during postoperative follow-up.The first reports of perioperative hypersensitivity reaction come from the 1990s, and knowledge on this subject has grown significantly over time.In many countries, multidisciplinary teams and organisations have been established to identify, monitor the occurrence of this phenomenon, and have set the directions of medical activities and have changed the rules and recommendations.There is no information about the occurrence of perioperative hypersensitivity reactions in many countries, and global assessment of the problem is underestimated. Additionally, there is a great need to develop a system to monitor their occurrence in other countries.The long-term epidemiologic studies have demonstrated variability in pharmacologic triggers. However, the main pharmacological substances (antibiotics, muscle relaxants, disinfectans, contrast agents) are related to aspects of patient safety during anaesthesia.
Collapse
Affiliation(s)
- Urszula Kosciuczuk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Bialystok, Białystok, Poland
| | - Pawel Knapp
- Department of Gynecology and Gynecological Oncology, Medical University of Bialystok, Białystok, Poland
| |
Collapse
|
5
|
Abstract
Perioperative anaphylaxis (PA) is a rare but life-threatening condition that poses diagnostic and management challenges in the operating room. The incidence of severe perioperative reactions is estimated to be approximately 1:7000-10,000. Management involves both immediate stabilization of the patient and identifying the culprit agent. Identification is essential to prevent recurrence of the event in subsequent surgeries and to avoid unnecessary labeling of drug allergy. Identifying all possible exposures including medications, disinfectants, latex, and dyes and choosing the appropriate tests are essential for proper evaluation. To identify the culprit, primary testing modalities include tryptase at the time of the reaction with subsequent levels and skin testing with nonirritating concentrations to the medications and substances utilized during the procedure and those potentially used as alternates. This strategy provides guidance for future surgeries and procedures. Close collaboration between the allergy, anesthesiology, and surgery teams is essential for appropriate management of these patients at the time of the reaction, during the post event evaluation and in preparation for subsequent surgeries.
Collapse
|
6
|
Relationship of perioperative anaphylaxis to neuromuscular blocking agents, obesity, and pholcodine consumption: a case-control study. Br J Anaesth 2021; 126:940-948. [PMID: 33454050 DOI: 10.1016/j.bja.2020.12.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 11/20/2020] [Accepted: 12/06/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The observation that patients presenting for bariatric surgery had a high incidence of neuromuscular blocking agent (NMBA) anaphylaxis prompted this restricted case-control study to test the hypothesis that obesity is a risk factor for NMBA anaphylaxis, independent of differences in pholcodine consumption. METHODS We compared 145 patients diagnosed with intraoperative NMBA anaphylaxis in Western Australia between 2012 and 2020 with 61 patients with cefazolin anaphylaxis with respect to BMI grade, history of pholcodine consumption, sex, age, comorbid disease, and NMBA type and dose. Confounding was assessed by stratification and binomial logistic regression. RESULTS Obesity (odds ratio [OR]=2.96, χ2=11.7, P=0.001), 'definite' pholcodine consumption (OR=14.0, χ2=2.6, P<0.001), and female sex (OR=2.70, χ2=9.61, P=0.002) were statistically significant risk factors for NMBA anaphylaxis on univariate analysis. The risk of NMBA anaphylaxis increased with BMI grade. Confounding analysis indicated that both obesity and pholcodine consumption remained important risk factors after correction for confounding, but that sex did not. The relative rate of rocuronium anaphylaxis was estimated to be 3.0 times that of vecuronium using controls as an estimate of market share, and the risk of NMBA anaphylaxis in patients presenting for bariatric surgery was 8.8 times the expected rate (74.9 vs 8.5 per 100 000 anaesthetic procedures). CONCLUSIONS Obesity is a risk factor for NMBA anaphylaxis, the risk increasing with BMI grade. Pholcodine consumption is also a risk factor, and this is consistent with the pholcodine hypothesis. Rocuronium use is associated with an increased risk of anaphylaxis compared with vecuronium in this population.
Collapse
|
7
|
Acker JV, Ebo D, Faber M, Sabato V, Suys E, Coghe M, Aerts O. A bad cough: Delayed cutaneous hypersensitivity caused by pholcodine. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:1449-1451. [PMID: 31726230 DOI: 10.1016/j.jaip.2019.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/10/2019] [Accepted: 10/28/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Julie Van Acker
- Department of Dermatology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Didier Ebo
- Department of Immunology, Allergology, Rheumatology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium; Infla-Med Centre of Excellence, Antwerp University, Antwerp, Belgium
| | - Margriet Faber
- Department of Immunology, Allergology, Rheumatology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium; Infla-Med Centre of Excellence, Antwerp University, Antwerp, Belgium
| | - Vito Sabato
- Department of Immunology, Allergology, Rheumatology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium; Infla-Med Centre of Excellence, Antwerp University, Antwerp, Belgium
| | - Erwin Suys
- Private Dermatologist, Handelskaai 1/G, Kortrijk, Belgium
| | - Marjan Coghe
- Private Dermatologist, Masteneikstraat 61/1, Izegem, Belgium
| | - Olivier Aerts
- Department of Dermatology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium.
| |
Collapse
|
8
|
Harman A, Tung A, Fox C, Lien CA. Heuristics, Overconfidence, and Experience: Impact on Monitoring Depth of Neuromuscular Blockade. Anesth Analg 2020; 128:1057-1059. [PMID: 31094765 DOI: 10.1213/ane.0000000000003965] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ann Harman
- From the American Board of Anesthesiology, Raleigh, North Carolina
| | - Avery Tung
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| | - Chris Fox
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cynthia A Lien
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
9
|
Stepanovic B, Sommerfield D, Lucas M, von Ungern-Sternberg BS. An update on allergy and anaphylaxis in pediatric anesthesia. Paediatr Anaesth 2019; 29:892-900. [PMID: 31379063 DOI: 10.1111/pan.13703] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 07/07/2019] [Accepted: 07/09/2019] [Indexed: 01/31/2023]
Abstract
Childhood allergy is common, and increasing. Many children are incorrectly labeled as having allergy or adverse drug reactions. This can pose a dilemma for anesthetists and lead to a change in practice or drug selection. We review the pathophysiology of hypersensitivity reactions and the implications for anesthesia of food allergy, atopy, and family history of allergy in children. The epidemiology of anaphylaxis is discussed. We discuss the common triggers of perioperative anaphylaxis in children and explore emerging triggers including chlorhexidine and sugammadex. Accurate data on pediatric perioperative anaphylaxis is limited worldwide, with marked geographic variation. This highlights the need for accurate local, district and/or nationwide incident reporting. The clinical features, diagnosis, and management of anaphylaxis under anesthesia are discussed. We review the process of expert allergy testing following a suspected case of anaphylaxis to guide future safe anesthesia administration. The preoperative consultation is an opportunity for referral for allergy testing to allow de-labeling. This has the potential for improved antibiotic stewardship and more effective treatment with first-line therapeutic agents.
Collapse
Affiliation(s)
- Bojana Stepanovic
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Michaela Lucas
- Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Department of Immunology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, Perth, Western Australia, Australia
| |
Collapse
|
10
|
Dardeer A, Shallik N. Perioperative anaphylaxis: A new visit to an old topic. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
11
|
Porebski G, Kwiecien K, Pawica M, Kwitniewski M. Mas-Related G Protein-Coupled Receptor-X2 (MRGPRX2) in Drug Hypersensitivity Reactions. Front Immunol 2018; 9:3027. [PMID: 30619367 PMCID: PMC6306423 DOI: 10.3389/fimmu.2018.03027] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/06/2018] [Indexed: 12/15/2022] Open
Abstract
The human ortholog MRGPRX2 and the mice ortholog, Mrgprb2 are activated by basic secretagogues and neurokinins. A number of commonly used small-molecule drugs (e.g., neuromuscular blocking agents, fluoroquinolones, vancomycin) have been recently shown to activate these receptors under in vitro experimental conditions, what results in mast cell degranulation. The above drugs are also known to cause IgE-mediated anaphylactic reactions in allergic patients. The new findings on mechanisms of drug-induced mast cell degranulation may modify the current management of drug hypersensitivity reactions. Clinical interpretation of mild drug-provoked hypersensitivity reactions, interpretation of skin test with a drug of interest or further recommendations for patients suspected of drug allergy are likely to be reconsidered. In the paper we discussed future directions in research on identification and differentiation of MRGPRX2-mediated and IgE-dependent mast cell degranulation in patients presenting clinical features of drug-induced hypersensitivity reactions.
Collapse
Affiliation(s)
- Grzegorz Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Kamila Kwiecien
- Department of Immunology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Magdalena Pawica
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Kwitniewski
- Department of Immunology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| |
Collapse
|
12
|
Egner W, Cook TM, Garcez T, Marinho S, Kemp H, Lucas DN, Floss K, Farooque S, Torevell H, Thomas M, Ferguson K, Nasser S, Karanam S, Kong KL, McGuire N, Bellamy M, Warner A, Hitchman J, Farmer L, Harper NJN. Specialist perioperative allergy clinic services in the UK 2018: Results from the Royal College of Anaesthetists Sixth National Audit Project (NAP6) investigation of perioperative anaphylaxis. Clin Exp Allergy 2018; 48:846-861. [DOI: 10.1111/cea.13180] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 12/18/2022]
Affiliation(s)
- W. Egner
- Sheffield Teaching Hospitals NHS Trust; Sheffield UK
- Department of Infection, Immunity and Cardiovascular Disease; University of Sheffield; Sheffield UK
- Royal College of Physicians/Royal College of Pathologists Joint Committee on Immunology and Allergy; University of Sheffield; London UK
| | - T. M. Cook
- Anaesthesia and Intensive Care Medicine; Royal United Hospital; Bath UK
- University of Bristol School of Medicine; Bristol UK
- National Audit Projects Program; Royal College of Anaesthetists; London UK
| | - T. Garcez
- United Kingdom Fatal Anaphylaxis Register; Manchester UK
- Manchester University NHS Foundation Trust; Manchester UK
| | - S. Marinho
- Manchester University NHS Foundation Trust; Manchester UK
- British Society of Allergy and Clinical Immunology; London UK
| | - H. Kemp
- Research and Audit Federation of Trainees; London UK
- Imperial College London; London UK
| | - D. N. Lucas
- Obstetric Anaesthetists Association; Harrow UK
- Northwick Park Hospital; Harrow UK
| | - K. Floss
- Royal Pharmaceutical Society of Great Britain; London UK
- Anaesthetics & Critical Care; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - S. Farooque
- Imperial College Healthcare NHS Trust; London UK
| | - H. Torevell
- Bradford Teaching Hospitals NHS Trust; Bradford UK
| | - M. Thomas
- Association of Paediatric Anaesthetists of Great Britain and Ireland; London UK
- Great Ormond Street Hospital; London UK
| | - K. Ferguson
- Association of Anaesthetists of Great Britain and Ireland; London UK
- Aberdeen Royal Infirmary; Aberdeen UK
| | - S. Nasser
- British Society for Allergy and Clinical Immunology; London UK
- Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - S. Karanam
- Sandwell and West Birmingham NHS Trust; Birmingham UK
| | - K.-L. Kong
- Sandwell and West Birmingham NHS Trust; Birmingham UK
| | - N. McGuire
- Medicines and Healthcare Regulatory Authority; London UK
| | - M. Bellamy
- Leeds Teaching Hospitals NHS Trust; Leeds UK
- Faculty of Intensive Care Medicine; Leeds University; Leeds UK
| | | | - J. Hitchman
- Lay Committee; Royal College of Anaesthetists; London UK
| | - L. Farmer
- Royal College of Anaesthetists; London UK
| | - N. J. N. Harper
- Manchester University NHS Foundation Trust; Manchester UK
- Royal College of Anaesthetists; London UK
- Manchester Academic Health Science Centre; University of Manchester; Manchester UK
| |
Collapse
|
13
|
Patton K, Borshoff DC. Adverse drug reactions. Anaesthesia 2018; 73 Suppl 1:76-84. [DOI: 10.1111/anae.14143] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 12/23/2022]
Affiliation(s)
- K. Patton
- Department of Anaesthesia; University Hospital Bristol; Bristol UK
| | - D. C. Borshoff
- Department of Anaesthesia and Pain Medicine; St. John of God Murdoch Hospital; Perth Western Australia
| |
Collapse
|
14
|
Iammatteo M, Keskin T, Jerschow E. Evaluation of periprocedural hypersensitivity reactions. Ann Allergy Asthma Immunol 2017; 119:349-355.e2. [DOI: 10.1016/j.anai.2017.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/08/2017] [Accepted: 07/11/2017] [Indexed: 12/18/2022]
|
15
|
Reclassifying Anaphylaxis to Neuromuscular Blocking Agents Based on the Presumed Patho-Mechanism: IgE-Mediated, Pharmacological Adverse Reaction or "Innate Hypersensitivity"? Int J Mol Sci 2017; 18:ijms18061223. [PMID: 28590439 PMCID: PMC5486046 DOI: 10.3390/ijms18061223] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 01/18/2023] Open
Abstract
Approximately 60% of perioperative anaphylactic reactions are thought to be immunoglobulin IgE mediated, whereas 40% are thought to be non-IgE mediated hypersensitivity reactions (both considered non-dose-related type B adverse drug reactions). In both cases, symptoms are elicited by mast cell degranulation. Also, pharmacological reactions to drugs (type A, dose-related) may sometimes mimic symptoms triggered by mast cell degranulation. In case of hypotension, bronchospasm, or urticarial rash due to mast cell degranulation, identification of the responsible mechanism is complicated. However, determination of the type of the underlying adverse drug reaction is of paramount interest for the decision of whether the culprit drug may be re-administered. Neuromuscular blocking agents (NMBA) are among the most frequent cause of perioperative anaphylaxis. Recently, it has been shown that NMBA may activate mast cells independently from IgE antibodies via the human Mas-related G-protein-coupled receptor member X2 (MRGPRX2). In light of this new insight into the patho-mechanism of pseudo-allergic adverse drug reactions, in which as drug-receptor interaction results in anaphylaxis like symptoms, we critically reviewed the literature on NMBA-induced perioperative anaphylaxis. We challenge the dogma that NMBA mainly cause IgE-mediated anaphylaxis via an IgE-mediated mechanism, which is based on studies that consider positive skin test to be specific for IgE-mediated hypersensitivity. Finally, we discuss the question whether MRGPRX2 mediated pseudo-allergic reactions should be re-classified as type A adverse reactions.
Collapse
|
16
|
Ue KL, Kasternow B, Wagner A, Rutkowski R, Rutkowski K. Sugammadex: An emerging trigger of intraoperative anaphylaxis. Ann Allergy Asthma Immunol 2016; 117:714-716. [PMID: 27789121 DOI: 10.1016/j.anai.2016.09.428] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Kok Loong Ue
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Bogusia Kasternow
- Department of Allergy, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Annette Wagner
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ryszard Rutkowski
- Department of Respiratory Diagnostics, Medical University of Bialystok, Bialystok, Poland
| | - Krzysztof Rutkowski
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| |
Collapse
|
17
|
Aalberse RC, Platts-Mills TA, Rispens T. The Developmental History of IgE and IgG4 Antibodies in Relation to Atopy, Eosinophilic Esophagitis, and the Modified TH2 Response. Curr Allergy Asthma Rep 2016; 16:45. [PMID: 27221343 PMCID: PMC5026408 DOI: 10.1007/s11882-016-0621-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A common reaction from anyone confronted with allergy is the question: what prevents universal allergy? We will discuss recent findings in the mouse system that have provided us with clues on why allergy is not more common. We will also address one crucial aspect of atopic allergy in humans, which is absent in most mouse model systems, an IgG/IgE ratio <10. We consider the typical mouse IgE response to be more closely related to the "modified TH2" response in humans. We will discuss the similarities and differences between the IgE and IgG4 response to allergens and an update on the IgG4 B cell, partly derived from studies on eosinophilic esophagitis and IgG4-related diseases.
Collapse
Affiliation(s)
- Rob C Aalberse
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, P.O. Box 9190, 1006 AD, Amsterdam, The Netherlands.
| | - Thomas A Platts-Mills
- Division of Allergy and Immunology, University of Virginia, Charlottesville, VA, USA
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, P.O. Box 9190, 1006 AD, Amsterdam, The Netherlands
| |
Collapse
|
18
|
Kline A, Fischer G. Acute generalised exanthematous pustulosis and other severe drug eruptions from over the counter medications: A case report and review of the literature. Australas J Dermatol 2016; 57:92-96. [PMID: 25880610 DOI: 10.1111/ajd.12336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/21/2015] [Indexed: 11/27/2022]
Abstract
We present a case of acute generalised exanthematous pustulosis in an 11-year-old girl who used Duro-Tuss, an over-the-counter cough mixture containing pholcodine, and present a comprehensive review of the literature on severe drug reactions resulting from using non-prescription medications. This case reinforces the importance of taking a complete medication history.
Collapse
Affiliation(s)
- Amy Kline
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Gayle Fischer
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
19
|
|
20
|
Macy E. Practical Management of Patients with a History of Immediate Hypersensitivity to Common non-Beta-Lactam Drugs. Curr Allergy Asthma Rep 2016; 16:4. [PMID: 26714689 DOI: 10.1007/s11882-015-0584-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Immediate hypersensitivity reactions to medications are among the most feared adverse drug reactions, because of their close association with anaphylaxis. This review discusses a practical management approach for patients with a history of an immediate hypersensitivity to a non-beta-lactam medication, where reexposure to the implicated, or similar, medication is clinically necessary. Mechanisms associated with severe immediate hypersensitivity reactions include IgE-mediated mast cell activation, complement-mediated mast cell activation, and direct mast cell activation. Immediate hypersensitivity reactions may also be mediated by vasodilators, other pharmacologic mechanisms, or be secondary to underlying patient-specific biochemical abnormalities such as endocrine tumors or chronic spontaneous urticaria. The key features in the reaction history and the biochemistry of the implicated medication are discussed. Most individuals with a history of immediate hypersensitivity to a medication, who require reuse of that drug, can be safely retreated with a therapeutic course of the implicated drug after a full-dose challenge, graded challenge, or desensitization, with or without premedication and/or any preliminary diagnostic testing, depending on the specific situation.
Collapse
Affiliation(s)
- Eric Macy
- Kaiser Permanente, Department of Allergy, 7060 Clairemont Mesa Blvd, San Diego, CA, 92111, USA.
| |
Collapse
|
21
|
Macy E. Practical Management of Patients with a History of Immediate Hypersensitivity to Common non-Beta-Lactam Drugs. Curr Allergy Asthma Rep 2016. [PMID: 26714689 DOI: 10.1007/s11882-015-0584-3)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Immediate hypersensitivity reactions to medications are among the most feared adverse drug reactions, because of their close association with anaphylaxis. This review discusses a practical management approach for patients with a history of an immediate hypersensitivity to a non-beta-lactam medication, where reexposure to the implicated, or similar, medication is clinically necessary. Mechanisms associated with severe immediate hypersensitivity reactions include IgE-mediated mast cell activation, complement-mediated mast cell activation, and direct mast cell activation. Immediate hypersensitivity reactions may also be mediated by vasodilators, other pharmacologic mechanisms, or be secondary to underlying patient-specific biochemical abnormalities such as endocrine tumors or chronic spontaneous urticaria. The key features in the reaction history and the biochemistry of the implicated medication are discussed. Most individuals with a history of immediate hypersensitivity to a medication, who require reuse of that drug, can be safely retreated with a therapeutic course of the implicated drug after a full-dose challenge, graded challenge, or desensitization, with or without premedication and/or any preliminary diagnostic testing, depending on the specific situation.
Collapse
Affiliation(s)
- Eric Macy
- Kaiser Permanente, Department of Allergy, 7060 Clairemont Mesa Blvd, San Diego, CA, 92111, USA.
| |
Collapse
|
22
|
Uyttebroek A, Leysen J, Bridts C, Ebo D. Letter to the authors concerning the accepted manuscript: exploring the link between pholcodine and neuromuscular anaphylaxis by Brush et al. Br J Clin Pharmacol 2015; 78:929-30. [PMID: 24611952 DOI: 10.1111/bcp.12374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 02/14/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Astrid Uyttebroek
- Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium; Immunology-Allergology-Rheumatology, Antwerp University Hospital, Antwerpen, Belgium
| | | | | | | |
Collapse
|
23
|
Brusch AM, Clarke RC, Platt PR, Phillips E. Response to letter regarding article 'Exploring the link between pholcodine exposure and neuromuscular blocking agent anaphylaxis'. Br J Clin Pharmacol 2015; 78:931-2. [PMID: 24611979 DOI: 10.1111/bcp.12375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/02/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Anna M Brusch
- Department of Clinical Immunology, Fremantle Hospital, Fremantle, WA, Australia
| | | | | | | |
Collapse
|
24
|
Kannan JA, Bernstein JA. Perioperative anaphylaxis: diagnosis, evaluation, and management. Immunol Allergy Clin North Am 2015; 35:321-34. [PMID: 25841554 DOI: 10.1016/j.iac.2015.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Perioperative anaphylaxis can occur during or after surgery and can have life-threatening consequences. As anesthesia protocols become more complex and incorporate multiple agents to regulate physiologic processes intraoperatively, perioperative anaphylaxis is becoming increasingly recognized. The allergist should obtain detailed records from the anesthesiologist in order to perform appropriate testing to identify the likely causative agents. Testing should ideally be performed 4 to 6 weeks after the reaction to account for a refractory period after mast cell activation. This article includes 2 cases of perioperative anaphylaxis and reviews the historical elements that must be considered after a reaction has occurred.
Collapse
Affiliation(s)
- Jennifer A Kannan
- Division of Immunology, Allergy and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, 3255 Eden Avenue, Suite 350, ML 563, Cincinnati, OH 45267-0563, USA
| | - Jonathan A Bernstein
- Division of Immunology, Allergy and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, 3255 Eden Avenue, Suite 350, ML 563, Cincinnati, OH 45267-0563, USA; Bernstein Clinical Research Center, 8444 Winton Road, Cincinnati, OH 45231, USA.
| |
Collapse
|
25
|
Barbier P, Scala-Bertola J, Gambier N, Rivier A, Demoré B, Gillet P, Nicolas A, Petitpain N. Stability of a 1.0 mg ml −1aqueous pholcodine solution for allergy skin testing. Br J Clin Pharmacol 2014; 78:1172-4. [DOI: 10.1111/bcp.12434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/08/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Nicolas Gambier
- Department of Clinical Pharmacology; Toxicology; CHRU Nancy; Nancy France
| | | | | | - Pierre Gillet
- Department of Clinical Pharmacology; Toxicology; CHRU Nancy; Nancy France
| | | | - Nadine Petitpain
- Department of Clinical Pharmacology; Regional Pharmacovigilance Centre; CHRU Nancy; Nancy France
| |
Collapse
|