Pre-lethal anaphylaxis to carboxymethylcellulose confirmed by identification of specific IgE--review of the literature.
BACKGROUND
Carboxymethylcellulose (CMC) is used extensively in the pharmaceutical and food industries on account of its various properties. Anaphylactic reactions are rare. It has been reported principally after intra-articular infiltration of sustained-release corticosteroids containing CMC and, very rarely, after barium enema.


METHODS
A case of pre-lethal anaphylactic shock after barium enema was studied by prick-test, intra-dermal reaction (IDR), leukocyte histamine release test (LHRT), basophil activation test (BAT), cystein-leukotriene release test (CAST) and dot-blot analysis.


RESULTS
IDR to CMC was positive at a concentration of 10 microg/ml. BAT and CAST were positive. Specific IgE were identified using dot-blot analysis.


CONCLUSIONS
This is the third report of CMC-specific IgE and the second of anaphylaxis to CMC associated with a barium suspension in contact with GI tract mucosa. CMC as an excipient in medicinal products may therefore be a risk factor for severe anaphylaxis after injection or following contact with GI tract mucosa. Sensitization and allergic reactions by CMC in food additives have to be considered.
Dumond
P
P
Department of Internal Medicine, Clinical Immunology and Allergology University Hospital, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy Cedex.
Franck
P
P
Morisset
M
M
Sainte Laudy
J
J
Kanny
G
G
Moneret-Vautrin
D A
DA
D000707:Anaphylaxis / Q000139:chemically induced*; D002266:Carboxymethylcellulose Sodium / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000209:etiology*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D008297:Male; D008875:Middle Aged
D007073:Immunoglobulin E; D002266:Carboxymethylcellulose Sodium