Anaphylaxis following administration of papaveretum. Case report: Implication of IgE antibodies that react with morphine and codeine, and identification of an allergenic determinant.
IgE antibodies that reacted with morphine and codeine were detected in the serum of a subject who experienced a life-threatening anaphylactic reaction following the administration of Omnopon-Scopolamine (papaveretum-hyoscine). Hapten inhibition studies with morphine and a number of structurally-related analogues revealed that morphine and codeine were the most potent inhibitors of IgE binding to a morphine-solid phase. Nalorphine, meperidine, and methadone were also good inhibitors of IgE binding, but naltrexone, buprenorphine, and fentanyl proved to be poor inhibitors. From a detailed examination of structure-activity relationships, the authors conclude that the important structural features of the morphine allergenic (that is, IgE binding) determinant comprises the cyclohexenyl ring with a hydroxyl group at C-6 and, most important of all, a methyl substituent attached to the N atom. The authors' findings suggest that morphine analogues administered to such a patient may provoke clinical anaphylaxis. Hyoscine reacted weakly with IgE antibodies in the subject's serum, but this was thought to be due to weak cross-reaction between this compound and morphine.
Harle
D G
DG
Kolling Institute of Medical Research, Royal North Shore Hospital, St. Leonards, N.S.W., Australia.
Baldo
B A
BA
Coroneos
N J
NJ
Fisher
M M
MM
D000707:Anaphylaxis / Q000139:chemically induced* / Q000276:immunology; D003061:Codeine / Q000276:immunology; D004338:Drug Combinations / Q000009:adverse effects; D000939:Epitopes / Q000032:analysis; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000096:biosynthesis / Q000276:immunology; D008875:Middle Aged; D009020:Morphine / Q000276:immunology; D009892:Opium / Q000009:adverse effects*; D011229:Preanesthetic Medication / Q000009:adverse effects*; D012601:Scopolamine / Q000009:adverse effects*
D004338:Drug Combinations; D000939:Epitopes; C061302:papaveretum-hyoscine; D007073:Immunoglobulin E; D009020:Morphine; D009892:Opium; D012601:Scopolamine; D003061:Codeine