Amphotericin-induced stridor: a review of stridor, amphotericin preparations, and their immunoregulatory effects.
BACKGROUND
Various adverse effects have been reported with the use of amphotericin B. The respiratory adverse effects include dyspnea, tachypnea, bronchospasm, hemoptysis, and hypoxemia. Stridor has not been previously reported with the use of amphotericin B.


OBJECTIVE
To review the mechanism of action and reports of respiratory adverse effects for amphotericin B, the liposomal preparations of amphotericin B, and the differential diagnosis of stridor.


METHODS
A MEDLINE search from 1966 to 2002 was performed to review the current literature for possible mechanisms and immunoregulatory effects related to the infusion of amphotericin B.


RESULTS
Amphotericin B has been shown to increase tumor necrosis factor alpha (TNF-alpha) concentrations in macrophages. In addition, it induces prostaglandin E2 synthesis and increases the production of interleukin 1beta (IL-1beta) in mononuclear cells. The immunoregulatory effects of amphotericin B include increases in apoptosis, production of monocyte chemoattractant protein 1, superoxide anion, nitric oxide, and intercellular adhesion molecule 1 expression.


CONCLUSIONS
Amphotericin B induces the production of TNF-alpha, interferon-gamma, and IL-1beta, which may potentiate its toxic effects. Some liposomal preparations induced lower levels of TNF-alpha and nitric oxide and may be useful in patients unable to tolerate amphotericin B deoxycholate.
Lowery
Margaret M
MM
Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Greenberger
Paul A
PA
D000208:Acute Disease; D000368:Aged; D000666:Amphotericin B / Q000009:adverse effects* / Q000276:immunology; D000935:Antifungal Agents / Q000009:adverse effects* / Q000276:immunology; D003937:Diagnosis, Differential; D004339:Drug Compounding / Q000009:adverse effects; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000276:immunology; D008297:Male; D012130:Respiratory Hypersensitivity / Q000139:chemically induced / Q000175:diagnosis / Q000276:immunology; D012135:Respiratory Sounds / Q000175:diagnosis / Q000209:etiology*
D000935:Antifungal Agents; D000666:Amphotericin B