title: Weal and flare responses to intradermal rocuronium and cisatracurium in humans.
abstract: Thirty volunteers underwent intradermal skin testing with increasing concentrations of rocuronium and cisatracurium to evaluate weal and flare responses, and whether either agent would cause mast cell degranulation and sensitization upon re-exposure. We found that intradermal injection of rocuronium and cisatracurium at concentrations > 10(-4) M resulted in positive weal (>8 mm) responses, and positive flare responses at > 10(-4) and > 10(-5) M respectively. Only cisatracurium caused mild to moderate mast cell degranulation, and neither drug caused significant in vitro histamine release from whole blood collected from study subjects 4 weeks after skin testing. Skin testing with rocuronium and cisatracurium should be performed at concentrations < 10(-4) and < 10(-5) M respectively to avoid false-positive responses. The ability of these agents to produce positive weal and flare responses at relatively low concentrations may explain the high incidence of potential reactions reported.
authors.affiliation: Department of Anesthesiology, Emory University Hospital, Atlanta, GA 30322, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Levy
authors.forename: M
authors.initials: M
authors.lastname: Gottge
authors.forename: F
authors.initials: F
authors.lastname: Szlam
authors.forename: R
authors.initials: R
authors.lastname: Zaffer
authors.forename: C
authors.initials: C
authors.lastname: McCall
mesh_terms: D000732:Androstanols / Q000008:administration & dosage / Q000633:toxicity*; D001279:Atracurium / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000633:toxicity*; D004305:Dose-Response Relationship, Drug; D003875:Drug Eruptions / Q000209:etiology* / Q000473:pathology; D006636:Histamine Release / Q000187:drug effects; D006801:Humans; D007428:Intradermal Tests / Q000379:methods; D008407:Mast Cells / Q000187:drug effects / Q000648:ultrastructure; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000633:toxicity*; D000077123:Rocuronium; D012867:Skin / Q000187:drug effects / Q000648:ultrastructure; D014581:Urticaria / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; C101584:cisatracurium; D000077123:Rocuronium