Letter to the Editor

Use of Naloxone in Hydromorphone-induced Anaphylactoid Reaction

Authors: Neil Mushlin, DO, Bobbak Vahid, MD, Robert Roberts, MD

Abstract

To the Editor:


Multiple agents are known to cause anaphylactic reactions after surgical or interventional procedures. Opioids are known to cause histamine release and anaphylactic reactions. The mechanisms of these reactions could be either IgE-dependent or IgE independent.1,2We describe a case of anaphylactoid reaction to hydromorphone responding to IV naloxone treatment.

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References

1. Casale TB, Bowman S, Kaliner M. Induction of human mast cell degranulation by opiates and endogenous opioid peptides: evidence for opiate and non-opiate receptor participation. J Allergy Clin Immunol 1984;73:755–781.
 
2. Dybendal T, Guttormsen AB, Elsayed S, et al. Screening for mast cell tryptase and serum IgE antibodies in 18 patients with anaphylactic shock during general anaesthesia. Acta Anaesthesiol Scand 2003;47:1211–1218.
 
3. Panos MZ, Burnett S, Gazzard BG. Use of naloxone in opioid-induced anaphylactoid reaction. Br J Anaesth 1988;61:371.
 
4. Amir S. Opiate antagonists reverse the hypoactivity associated with systemic anaphylaxis in mice. Pharmacol Biochem Behav 1984;20:483–485.