[Anaphylaxis to muscle relaxants. Predictive value of intradermal tests and study of crossed anaphylaxis].
37 patients were studied, all of whom presented with anaphylaxis to a muscle relaxant. The diagnosis was made after simultaneous intradermal testing (IDT), human basophil degranulation tests (HBDT) and Prausnitz-Küstner tests (PK) of passive cutaneous anaphylaxis. Three tests were positive in 6 patients, both IDT and PK in 9, and both IDT and HBDT in 8. In 14 patients, the IDT, repeated twice, were positive both times. A search for crossed anaphylaxis to the other muscle relaxants was carried out in all the patients during a second series of tests, a few months to years after the first one. The drugs tested, at dilutions of the pharmaceutical preparation of 10(-3) or more, were: suxamethonium, gallamine, alcuronium, pancuronium, vecuronium, d-tubocurarine. The reliability of IDT in the diagnosis of anaphylaxis is discussed in terms of the small reactive concentration, the producibility of the tests, the one HBDT that did become positive later, and in one case the occurrence of shock by crossed anaphylaxis. Skin reactivity seemed to remain constant with time, so allowing the use of IDT as a diagnostic tool, in cases of old anaphylactoid shocks, occurring during general anaesthetics. The frequency of crossed anaphylaxis was assessed to be about 84%. The sensitivity to one or other drugs varied with each patient. Pancuronium and vecuronium appeared to be the least likely drugs to cause crossed anaphylaxis. The predictive use of these tests is discussed. It is also suggested that muscle relaxants with only one quaternary ammonium group should be used, this chemical characteristic probably reducing the risks of sensitization.
Moneret-Vautrin
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Mouton
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D000293:Adolescent; D000328:Adult; D000707:Anaphylaxis / Q000139:chemically induced / Q000276:immunology*; D005260:Female; D006801:Humans; D007428:Intradermal Tests; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D000644:Quaternary Ammonium Compounds / Q000032:analysis; D012306:Risk; D012882:Skin Tests; D013329:Structure-Activity Relationship; D013390:Succinylcholine / Q000009:adverse effects*
D003473:Neuromuscular Nondepolarizing Agents; D000644:Quaternary Ammonium Compounds; D013390:Succinylcholine
Anaphylaxie aux myorelaxants. Valeur prédictive des intradermoréactions et recherche de l'anaphylaxie croisée.