title: Non-IgE-Dependent Hypersensitivity to Rocuronium Reversed by Sugammadex: Report of Three Cases and Hypothesis on the Underlying Mechanism.
abstract: We present 3 cases of pseudoallergic (anaphylactoid) reactions to perioperatively administered rocuronium, which rapidly resolved after sugammadex injection. Allergological workup showed no evidence for immediate-type hypersensitivity to the drugs used for anesthesia, including rocuronium. However, rocuronium induced an irritative reaction in skin tests in all 3 patients and in 3 healthy individuals. This reaction was specifically suppressed by adding sugammadex at a 1:1 molecular proportion to rocuronium before the skin tests. This observation suggests that the patients suffered from a pseudoallergic reaction, and indicates that sugammadex might act via the inhibition of non-IgE mediated MRGPRX2 (Mas-related G-protein-coupled receptor member X2)-triggered mast cell degranulation induced by rocuronium.
authors.affiliation: Division of Clinical Immunology and Allergy, Department of Medical Specialties, Geneva University Hospital, Geneva, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Spoerl
authors.forename: Stéphanie
authors.initials: S
authors.lastname: D'Incau
authors.forename: Pascale
authors.initials: P
authors.lastname: Roux-Lombard
authors.forename: Thomas
authors.initials: T
authors.lastname: Harr
authors.forename: Christoph
authors.initials: C
authors.lastname: Czarnetzki
mesh_terms: D000328:Adult; D000368:Aged; D000732:Androstanols / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D010641:Phenotype; D000077123:Rocuronium; D012882:Skin Tests; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000627:therapeutic use*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium