title: Utility of opium seed extract tests in preventing hypersensitivity reactions during surgery.
abstract: BACKGROUND
  Anaphylaxis during anaesthesia is fatal in 3-9% of patients and analgesics, including opioids, and is the second most common medicament-related cause, although the prevalence is underestimated. We recently found that patients may generate IgE antibodies to opium seeds.
  
  
  OBJECTIVE
  To determine the diagnostic accuracy of specific antibodies to morphine, codeine, rocuronium and oil body and aqueous fractions of Papaver somniferum seeds in the diagnosis and prevention of allergy to opioids.
  
  
  METHODS
  Patients with hypersensitivity reactions during surgery, and severe clinical allergy (pollen, tobacco), and illicit heroin users were selected. The sensitivity, specificity and predictive values of in vivo and in vitro diagnostic techniques including oil body and aqueous fractions of P. somniferum seeds were measured.
  
  
  RESULTS
  We studied 203 patients, with mean age 35.1±17.1 and 200 healthy controls. Patients sensitised to heroin or with hypersensitivity reactions during surgery responded to P. somniferum seed tests. Of patients not known to be sensitised to opioids, the highest positivity was in patients sensitised to tobacco (p<0.001). Opium seed skin tests and IgE, especially the oil body fraction, were more sensitive (64.2%) and specific (98.4%) than morphine, codeine and rocuronium tests for opioid sensitivity. Pollen allergy was not a risk factor for sensitisation to morphine.
  
  
  CONCLUSIONS
  Sensitivity to opioids and intraoperative anaphylaxis can be diagnosed by routine tests. IgE and skin tests for the oil body fraction of P. somniferum had the highest sensitivity for sensitisation to opioids.
authors: Allergy Unit, Rio Hortega University Hospital, UMDAI, Valladolid, Spain. Electronic address: aliciaarmentia@gmail.com.
authors: A
authors: A
authors: Armentia
authors: DIATER Laboratories, Madrid, Spain.
authors: F
authors: F
authors: Pineda
authors: DIATER Laboratories, Madrid, Spain.
authors: R
authors: R
authors: Palacios
authors: Clinical Chemistry Service, Hospital Universitario Rio Hortega, Valladolid, Spain.
authors: F-J
authors: FJ
authors: Martín-Gil
authors: Clinical Chemistry Service, Hospital Universitario Rio Hortega, Valladolid, Spain.
authors: A S
authors: AS
authors: Miguel
authors: Surgical Service, Hospital Universitario Rio Hortega, Valladolid, Spain.
authors: J J
authors: JJ
authors: Arenal
authors: Health Area Director, Delegacion del Gobierno de Castilla y León, Spain.
authors: J
authors: J
authors: Tejedor
authors: Research Unit, IEN, Rio Hortega University Hospital, Valladolid, Spain.
authors: B M
authors: BM
authors: Tef
mesh_terms: D000328:Adult; D000485:Allergens / Q000276:immunology*; D000701:Analgesics, Opioid / Q000276:immunology*; D000707:Anaphylaxis / Q000209:etiology / Q000517:prevention & control*; D000888:Antibodies, Anti-Idiotypic / Q000378:metabolism; D004342:Drug Hypersensitivity / Q000150:complications; D005260:Female; D006801:Humans; D007114:Immunization; D007073:Immunoglobulin E / Q000097:blood; D007159:Immunologic Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009892:Opium / Q000276:immunology*; D010207:Papaver / Q000276:immunology; D010936:Plant Extracts; D011183:Postoperative Complications / Q000517:prevention & control*; D011237:Predictive Value of Tests; D012639:Seeds / Q000276:immunology; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: C405618:105AD7 antibody; D000485:Allergens; D000701:Analgesics, Opioid; D000888:Antibodies, Anti-Idiotypic; D010936:Plant Extracts; D007073:Immunoglobulin E; D009892:Opium
keywords: Anaesthesia; Analgesia; Anaphylaxis; Opioids; Papaver somniferum