title: Pholcodine consumption and immunoglobulin E-sensitization in atopics from Australia, Korea, and Japan.
abstract: BACKGROUND
  Accumulating data indicates that pholcodine (PHO)-consuming countries have higher sero-prevalences of immunoglobulin E (IgE)-antibodies to PHO and suxamethonium (SUX) and increased frequencies of IgE-mediated anaphylaxis to neuromuscular blocking agents (NMBAs) than nonconsuming. Withdrawing PHO-containing cough syrups resulted in a significant decrease of cases with anaphylaxis in Scandinavia. Nevertheless, the European Medicines Agency in 2011 advised to continue the unrestricted use throughout the European Union.
  
  
  OBJECTIVE
  To extend studies on PHO consumption and prevalence of IgE-sensitization to morphine (MOR), PHO, and SUX to countries representing high (Australia), and low (Korea and Japan), consumers, respectively.
  
  
  METHODS
  IgE-antibodies to SUX, MOR, and PHO in atopic subjects were determined by immunoassay and compared with official figures for PHO consumption and reported anaphylaxis to NMBA.
  
  
  RESULTS
  The prevalences of IgE-antibodies to PHO, MOR, and SUX were 10%, 8.6%, and 4.3%, respectively, in Australia. The corresponding figures for Japan were 0.8%, 0.8%, and 1.5%, and for Korea 1.0% to PHO and 0.5% to MOR and SUX. Of the SUX-positive sera, 100% were positive to PHO or MOR in Australia and 0% in Japan and Korea.
  
  
  CONCLUSIONS
  The study supports previous findings; exposure to PHO may induce IgE-antibodies to the substituted ammonium ion epitope of NMBAs, thus increasing risk of NMBA-induced anaphylaxis considerably. However, other, still unknown factors occasionally might induce IgE-antibodies to SUX.
authors.affiliation: Campbelltown Hospital, University of Western Sydney, Sydney 2560, Australia.
authors.forename: Constance H
authors.initials: CH
authors.lastname: Katelaris
authors.affiliation: Gunma Institute for Allergy and Asthma, Tatebayashi-Kosei Hospital, Tatebayashi 374-0055, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Kurosawa
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan Collage of Medicine, Seoul 138-736, Korea.
authors.forename: Hee-Bom
authors.initials: HB
authors.lastname: Moon
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Thermo Fisher Scientific, Uppsala 751 05, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Borres
authors.affiliation: Laboratory of Clinical Biochemistry, Department of Occupational Medicine, Haukeland University Hospital, Bergen 0027, Norway. ; Department of Clinical Science, University of Bergen, Bergen N-5020, Norway.
authors.forename: Erik
authors.initials: E
authors.lastname: Florvaag
authors.affiliation: Department of Medicine, Clinical Immunology and Allergy Unit, Karolinska University Hospital, Stockholm SE-141 86, Sweden.
authors.forename: Stig Gunnar Olof
authors.initials: SG
authors.lastname: Johansson
keywords: Anaphylaxis; General anaesthesia; IgE; Neuromuscular blocking agent; Pholcodine