title: Anaphylaxis to neuromuscular blocking drugs: incidence and cross-reactivity in Western Australia from 2002 to 2011.
abstract: BACKGROUND
  Neuromuscular blocking drugs (NMBDs) are the most common cause of intraoperative anaphylaxis in Western Australia. Differences in the rates of anaphylaxis between individual agents have been surmised in the past, but not proven, and are an important consideration if agents are otherwise equivalent.
  
  
  METHODS
  We estimated a rate of anaphylaxis to NMBDs by analysing cases of NMBD anaphylaxis referred to the only specialized diagnostic centre in Western Australia over a 10 yr period. Exposure was approximated by analysing a 5 yr period of NMBD ampoule sales data. Agents were also ranked according to the prevalence of cross-reactivity in patients with previous NMBD anaphylaxis.
  
  
  RESULTS
  Rocuronium was responsible for 56% of cases of NMBD anaphylaxis, succinylcholine 21%, and vecuronium 11%. There was no difference in the severity of reactions for different NMBDs. Rocuronium had a higher rate of IgE-mediated anaphylaxis compared with vecuronium (8.0 vs 2.8 per 100,000 exposures; P=0.0013). The prevalence of cross-reactivity after NMBD anaphylaxis suggested that succinylcholine also has a high risk of triggering anaphylaxis. Cisatracurium had the lowest prevalence of cross-reactivity in patients with known anaphylaxis to rocuronium or vecuronium.
  
  
  CONCLUSIONS
  Rocuronium has a higher rate of IgE-mediated anaphylaxis compared with vecuronium, a result that is statistically significant and clinically important. Cisatracurium had the lowest rate of cross-reactivity in patients who had previously suffered anaphylaxis to rocuronium or vecuronium.
authors: Sir Charles Gairdner Hospital, Perth, Western Australia. paul.sadleir@uwa.edu.au
authors: P H M
authors: PH
authors: Sadleir
authors: R C
authors: RC
authors: Clarke
authors: D L
authors: DL
authors: Bunning
authors: P R
authors: PR
authors: Platt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000707:Anaphylaxis / Q000453:epidemiology*; D000732:Androstanols / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003429:Cross Reactions; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects* / Q000276:immunology; D000077123:Rocuronium; D013997:Time Factors; D014673:Vecuronium Bromide / Q000009:adverse effects; D014904:Western Australia / Q000453:epidemiology
chemical_list: D000732:Androstanols; D009466:Neuromuscular Blocking Agents; D014673:Vecuronium Bromide; D000077123:Rocuronium
keywords: anaphylaxis; cross-reactivity; neuromuscular blocking drugs; rocuronium