Ethylmorphine hydrochloride/rocuronium bromide/suxamethonium chloride
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Anaphylaxis (first report with ethylmorphine hydrochloride): 2 case reports Two men developed anaphylaxis during treatment with ethylmorphine hydrochloride (patient 1) or rocuronium bromide and, subsequently, suxamethonium chloride (patient 2). Patient 1, a 35-year-old man, ingested a cough syrup containing ethylmorphine hydrochloride [dosage and therapeutic indication not stated]. After 10–20 minutes, he developed dizziness, facial oedema, an itchy head and hypotension. Anaphylaxis was suspected and he was treated. [Patient outcome not stated.] Prick testing with morphine (10mg/mL) was positive and he had a morphine IgE level of 2.0 kUA/L. However, an incremental IV morphine provocation test did not elicit any clinical reaction with morphine doses of 0.0005–5mg. Patient 2, a 51-year-old man, underwent anaesthesia for cardiac surgery. On rocuronium bromide injection, he developed tachycardia, generalised rash and hypotension [dosage and time to reaction onset not stated]. Anaphylaxis was suspected and he was treated. Surgery was postponed. Two weeks later, he underwent anaesthesia with suxamethonium chloride [dosage not stated] and anaphylaxis recurred [time to reaction onset and patient outcome not stated.] Prick testing with morphine (0.5 mg/dL) was negative and IV morphine provocation tests with concentrations up to 0.5mg did not elicit any clinical reaction. He had a morphine IgE level of 8.22 kUA/L. Author comment: "A correlation between morphine IgE and allergy to neuromuscular blocking agents (NMBA’s) is suggested as morphine and NMBA’s share the quaternary ammonium ion epitope." de Pater G, et al. Allergy to morphine - fact or fiction? Acta Anaesthesiologica Scandinavica Supplementum 51 (Suppl. 118): 48 abstr. 68, 2007 [abstract] 801082099 Norway
» Editorial comment: A search of AdisBase, Medline and the WHO Adverse Drug Reactions database did not reveal any previous case reports of anaphylaxis associated with ethylmorphine hydrochloride.
0114-9954/10/1170-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 22 Sep 2007 No. 1170
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