The Drug-Induced Respiratory Disease Website
An absolute emergency. Anaphylaxis and anaphylactoid reactions (Review at PMID 28800865). Drug-induced anaphylaxis can be fatal (PMID 25280385). Drugs (NSAIDs, antibiotics, RCM) are foremost as a cause of anaphylaxis (PMID: 25553259). Expression is more severe and treatment more difficult in patients who were receiving beta-blockers prior to the episode (PMID 6114116, 6146275). Angioedema, bronchospasm, shock common. Consider i.m. epinephrine and liberal fluid administration quickly. See also under shock (XIIn ) and PMID 17378256 & 22467837. Anaphylaxis and anaphylactoid reactions usually develop unexpectedly. Can be severe and/or prolonged. Fatal in about 2%. Clinically, anaphylaxis is a systemic reaction with flushing, cramping, shock, laryngeal edema, bronchospasm, pulmonary edema, arrhythmia, cardiac arrest, empty vena cava syndrome, and/or the locked lung. Can lead to death within minutes from angioedema, bronchospasm, cardiac arrest and/or pulmonary edema (PMID: 16916722, 22467837). Rechallenge with the drug must be avoided. See also under IVb, VIIIa and b and X. Guidelines at PMID 15753926. Reviews, epidemiologic surveys at PMID 10823122, 12733472, 15073989, 16916722, 1789822,19217731, 19901808, 22987983, 22467837, 23741979, 24881890, 25538414, 28611774, 29950872. Operative anaphylaxis is a severe form of anaphylaxis: PMID 19143700, 24251246, 22467837. All drugs that cause anaphylaxis may not be listed here. Guidelines, see also under PMID 24909803 and http://publications.nice.org.uk/anaphylaxis-assessment-to-confirm-an-anaphylactic-episode-and-the-decision-to-refer-after-emergency-cg134/introduction. A series of DI anaphylaxis with >1000 cases has been published in 2017 (PMID 29086147). Rechallenge with the drug must be avoided (PMID 28611774).
Publications
Anaphylaxis mortality in the perioperative setting: Epidemiology, elicitors, risk factors and knowledge gaps.
Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology 2024 Jan;54;11-20 — 2024 Jan — 11-20
Gouel-Chéron A, Neukirch C, Aubier B, Montravers P, Nicaise P, Chollet-Martin S, Mertes PM, Aubier M, Longrois D
Anaphylactic bronchospasm during general anesthesia is not related to asthma.
Allergy 2015 Apr;70;453-6 — 2015 Apr — 453-6
Multiple cross-reactivity to several types of neuromuscular blocking agents in a patient with rocuronium anaphylaxis.
Korean journal of anesthesiology 2013 Nov;65;473-4 — 2013 Nov — 473-4
Severe drug-induced anaphylaxis: analysis of 333 cases recorded by the Allergy Vigilance Network from 2002 to 2010.
Allergy 2013 Jul;68;929-37 — 2013 Jul — 929-37
Muscle relaxants allergy.
International journal of immunopathology and pharmacology 2011 Jul-Sep;24;S35-46 — 2011 Jul-Sep — S35-46
Rocuronium bromide induced anaphylaxis in a child -A case report-.
Korean journal of anesthesiology 2010 Dec;59;411-5 — 2010 Dec — 411-5
The clinical spectrum of anaphylaxis in north-west England.
Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology 1996 Dec;26;1364-70 — 1996 Dec — 1364-70
Muscle relaxants and histamine release.
Acta anaesthesiologica Scandinavica. Supplementum 1995;106;7-12 — 1995 — 7-12
Allergic reactions during anesthesia.
Anesthesia and analgesia 1983 Mar;62;341-56 — 1983 Mar — 341-56