Mod12: Anaphylactic vs Anaphylactoid Reactions - What causes reaction?

Question 1

_{Anaphylactic vs Anaphylactoid Reactions}

Based on 5,644 cases of anaphylaxis during anesthesia over 25 years (1980-2004), what’s the most common cause of an allergic reaction during anesthesia?

Answer 1

Muscle relaxants 3,509 (62%)

_{<strong>Latex</strong> 955 (17%)}

_{<strong>Antibiotics </strong> 365 (6.4%)}

_{Hypnotics 349 (6.1%)}

_{Colloids 194 (3.4%)}

_{Opioids 112 (1.9%)}

_{Others 160 (2.8%)}

Question 2

_{Anaphylactic vs Anaphylactoid Reactions}

What are causes of allergic reactions that are not unique to anesthesia?

Answer 2

Latex 955 (17%)

Antibiotics 365 (6.4%)

Question 3

_{Anaphylactic vs Anaphylactoid Reactions}

From NMBA – 3,509 cases, which muscle relaxants are the most a/w allergic reactions?

Answer 3

Succinylcholine 1,437 (41%)

Rocuronium 905 (25%)

_{Atracurium 475 (13%)}

_{Vecuronium 387 (11%)}

_{Pancuronium 251 ( 7%)}

_{Mivacurium 40 ( 1%)}

_{Cisatracurium 11 (0.3%)}

_{Others 3 (0.08%)}

Question 4

_{Anaphylactic vs Anaphylactoid Reactions}

Why do we see a higher incidence of hypersensitivity reaction right at induction?

Answer 4

Because that’s when we administer large quantities of muscle relaxants

_{Remember that anaphylactoid will be dose dependent}

_{Anaphylactic reaction will not}

Question 5

_{Anaphylactic vs Anaphylactoid Reactions}

From a French Study of 789 anaphylactic and anaphylactoid reactions, what were the leading causes of these reactions during anesthesia?

Answer 5

NMB 58%

Latex 17%

Antibiotics 15%

Question 6

_{Anaphylactic vs Anaphylactoid Reactions}

True or False: NMBA can produce dose-dependent, nonimmunologic histamine release related to the rate of administration

Answer 6

True

Question 7

_{Anaphylactic vs Anaphylactoid Reactions}

Which specific structure in muscle relaxants is responsible for allergic reaction

Answer 7

Quaternary ammonium ion

Question 8

_{Anaphylactic vs Anaphylactoid Reactions - NMBA}

In what percentage of cases is cross sensitivity with one or more muscle relaxants seen?

Answer 8

63% of cases

Question 9

_{Anaphylactic vs Anaphylactoid Reactions - NMBA}

True or False: Muscle relaxants cross-react with compounds containing quaternary and tertiary ammonium ions

Answer 9

True

Question 10

_{Anaphylactic vs Anaphylactoid Reactions - NMBA}

Muscle relaxants cross-react with compounds containing quaternary and tertiary ammonium ions. Which substances contain these ions?

Answer 10

Many drugs - Foods - Cosmetics

Disinfectants - Industrial materials

Νeostigmine and morphine

Question 11

_{Anaphylactic vs Anaphylactoid Reactions}

Which anesthetic drugs will you be hesitant to administer to a pt with a known anaphylactic reaction to Neostigmine or Morphine?

Answer 11

NMBAs

Question 12

_{Anaphylactic vs Anaphylactoid Reactions - NMBA}

Why do 90% to 95% of anaphylactic reactions to muscle relaxants occur in women?

Answer 12

Exposure to ammonium ion epitopes in cosmetics may elicit sensitization

Patients may become sensitized through environmental contact with these substances

Question 13

_{Anaphylactic vs Anaphylactoid Reactions - Latex Hypersensitivity}

Which three groups are at higher risk to of Latex Hypersensitivity and reaction

Answer 13

Health care workers

Children with spina bifida and genitourinary abnormalities

Workers with occupational exposure to latex

Question 14

_{Anaphylactic vs Anaphylactoid Reactions - Latex Hypersensitivity}

True or False: The more you are exposed to latex, the more your risk of being hypersensitive to it goes up

Answer 14

True

Question 15

_{Anaphylactic vs Anaphylactoid Reactions - Latex Hypersensitivity}

True or False: Latex Hypersensitivity should be considered as a possible cause of any reaction that occurs during anesthesia

Answer 15

True

Question 16

_{Anaphylactic vs Anaphylactoid Reactions - Latex Hypersensitivity}

When during anesthesia do most cases of latex-induced anaphylaxis occur?

Answer 16

about 30 minutes after induction

Question 17

_{Anaphylactic vs Anaphylactoid Reactions - Latex Hypersensitivity}

Which food items may contain cross-reacting allergens that could cause latex hypersensitivity?

Answer 17

Mango - Banana - Avocado

Kiwi - Passion fruit - Chestnuts

Question 18

_{Anaphylactic vs Anaphylactoid Reactions}

Which potential hypersensitivity reaction would you consider in a patient with allergies to these food items: Mango, Banana, Avocado, Kiwi, Passion fruit, Chestnuts?

Answer 18

Latex Hypersensitivity

Question 19

_{Anaphylactic vs Anaphylactoid Reactions - Latex Hypersensitivity}

Patients who have systemic reactions to latex during anesthesia often have a prior history of contact urticaria or angioedema from which other synthetic items?

Answer 19

Rubber gloves - Balloons - Condoms

Question 20

_{Anaphylactic vs Anaphylactoid Reactions - Latex Hypersensitivity}

Why would you ask someone who reports a latex allergy if they use special underwear?

Answer 20

Most underwear have some form of latex in the banding

Someone with a true anaphylactic reaction to latex will tell you they cannot wear standard underwear

They will have to purchase special underwear with zero latex

If they wear normal underwear and never had any issues, they may have hypersensitivity, but not anaphylaxis to latex

Question 21

_{Anaphylactic vs Anaphylactoid Reactions - Latex Hypersensitivity}

True or False: you should remove rubber stoppers from drug vials in potential hypersensitivity or anaphylaxis to latex

Answer 21

True

_{(Not completely necessary according to some litterature)}

Question 22

_{Anaphylactic vs Anaphylactoid Reactions}

Under anesthesia, which is the most frequent cause of anaphylaxis among antibiotics?

Answer 22

Penicillin

Estimated to be responsible for 75% of anaphylactic deaths in the United States

Question 23

_{Anaphylactic vs Anaphylactoid Reactions}

True or False: over 80% of patients with a history of allergy to penicillin have penicillin specific IgE antibodies as detected by skin testing

Answer 23

False

Over 80% of patients with a history of allergy to penicillin do not have penicillin specific IgE antibodies as detected by skin testing

Question 24

_{Anaphylactic vs Anaphylactoid Reactions}

What’s the similarity between Cephalosporins and Penicillin’s which accounts for varying degrees of cross-reactivity between the two?

Answer 24

Common beta-lactam ring structure

Question 25

_{Anaphylactic vs Anaphylactoid Reactions} According to recent litterature, what's the probability of the risk of allergic reactions to cephalosporins in patients allergic to penicillin?

Answer 25

Less than 10%

Question 26

_{Anaphylactic vs Anaphylactoid Reactions} Which generation of cephalosporins poses a greater risk of cross-reactivity with Penicillins

Answer 26

**First generation cephalosporins (Ancef)** _{pose a greater risk than second or third generation cephalosporins (Ceftin, Zinacef, Cefotaxime, Rocephin)}

Question 27

_{Anaphylactic vs Anaphylactoid Reactions} What could you do to test if a cephalosporin drug has cross-reactivity with Penicillin?

Answer 27

Give 10% of the dose IV to see if they have a reaction Do a little skin wheel and leave for 5 minutes and look for a reaction Should see redness erythema develop w/in 1st 5 min If not, ok to administer test dose, followed with full dose

Question 28

_{Anaphylactic vs Anaphylactoid Reactions} True or False: incidence of allergic reactions with colloids seems to be increasing

Answer 28

True

Question 29

_{Anaphylactic vs Anaphylactoid Reactions} Of the synthetic colloids, which one is more likely to cause a reaction?

Answer 29

**Dextran** (about the same or a little less than albumin)

Question 30

_{Anaphylactic vs Anaphylactoid Reactions} What's the % risk of allergic reaction for both Dextran and Albumin?

Answer 30

They are both around 0.5 - 1% risk of causing an allergic reaction

Question 31

_{Anaphylactic vs Anaphylactoid Reactions} True or False: reactions from colloids are _more common_ in **males** than females

Answer 31

True

Question 32

_{Anaphylactic vs Anaphylactoid Reactions} True or False: Egg allergy is a contraindication to use of albumin

Answer 32

**False** Egg allergy is not a contraindication to use of albumin (different protein)

Question 33

_{Anaphylactic vs Anaphylactoid Reactions} What causes Reactions to opioids?

Answer 33

**Direct mast cell mediator release** (Mimic IgE-dependent mechanisms, but is actually from the histamine release)

Question 34

_{Anaphylactic vs Anaphylactoid Reactions} Which opioid produces greatest histamine release?

Answer 34

**Demerol** Morphine also has a significant histamine release

Question 35

_{Anaphylactic vs Anaphylactoid Reactions} Most opioid-induced reactions are not life threatening; which symptoms are they associated with?

Answer 35

Mild hypotension (most common) Hives - Pruritus

Question 36

_{Anaphylactic vs Anaphylactoid Reactions} Which drugs could be used to treat symptoms associated with opioid-induced reactions?

Answer 36

Benadryl Steroids

Question 37

_{Anaphylactic vs Anaphylactoid Reactions} Which opioids should you avoid if you are concerned about hypotension?

Answer 37

Demerol Morphine

Question 38

_{Anaphylactic vs Anaphylactoid Reactions} Which type of hypersensitivity reaction is associated with Aspirin and NSAIDs?

Answer 38

Non-IgE-mediated adverse effects

Question 39

_{Anaphylactic vs Anaphylactoid Reactions} Which systemic effects result from ASA and NSAIDs that resemble allergic reactions

Answer 39

Bronchospasm Urticaria Angioedema Laryngeal edema

Question 40

_{Anaphylactic vs Anaphylactoid Reactions} True of False: there is a test to identify patients who are intolerant to ASA or NSAIDs

Answer 40

**False** No definitive skin or in vitro test to identify patients who are intolerant to ASA or NSAIDs exist

Question 41

_{Anaphylactic vs Anaphylactoid Reactions} True or False: only nonimmune mechanisms have been reported with Protamine

Answer 41

**False** Both nonimmune and immune (IgE) mechanisms have been reported with Protamine

Question 42

_{Anaphylactic vs Anaphylactoid Reactions} Which patients are more likely to have a life-threatening adverse reaction to intravenous protamine?

Answer 42

**Diabetics** who have had treatment with protamine-containing insulin They are **40 to 50 times** more likely to have a life-threatening adverse reaction to intravenous protamine **Men** that have had **_vasectomies_** ^{(Probably because Protamine was originally made from salmon sperms)}

Question 43

_{Anaphylactic vs Anaphylactoid Reactions} IgE-mediated systemic anaphylaxis is rare with local anesthetics. Which compounds are linked to local anesthetics related anaphylactic reactions when they occur?

Answer 43

P**ara-amino-benzoic** **acid** metabolite from esters, or The preservative M**ethylparaben**

Question 44

_{Anaphylactic vs Anaphylactoid Reactions - Local anesthetics} In patients who have had reactions to an ester-type local anesthetic, which LA should be considered for dose testing?

Answer 44

an Amide LA | (and vice versa)

Question 45

_{Anaphylactic vs Anaphylactoid Reactions - Local anesthetics} If the patient had a reaction to an amide, which LA may be used? why?

Answer 45

another **Amide** may be used because the cross reactivity among amides is rare

Question 46

_{Anaphylactic vs Anaphylactoid Reactions - Local anesthetics} True or False: Cross reactivity among amides is rare

Answer 46

True

Question 47

_{Anaphylactic vs Anaphylactoid Reactions} What's **Methyl-meth-acrylate**?

Answer 47

Glue used in orthopedic surgery | (Bone cement??)

Question 48

_{Anaphylactic vs Anaphylactoid Reactions - Methylmethacrylate} Which effects are associated with an allergic reaction to **Methyl-meth-acrylate**?

Answer 48

Hypotension - Hypoxemia Noncardiogenic pulmonary edema Cardiac arrest

Question 49

_{Anaphylactic vs Anaphylactoid Reactions - Methylmethacrylate} What is **Methyl-meth-acrylate** allergic mechanism?

Answer 49

No known

Question 50

_{Anaphylactic vs Anaphylactoid Reactions - Radiocontrast materials (RCM)} True or False: anaphylactoid reactions from Radiocontrast materials (RCM) are clinically _indistinguishable_ from IgE-mediated anaphylaxis

Answer 50

True

Question 51

_{Anaphylactic vs Anaphylactoid Reactions - Radiocontrast materials (RCM)} Why is it important to ask the pt when they had a reaction to RCM?

Answer 51

Most reactions a/w older RCM from the 70s Newer RCMs are not a/w with the same level of reactions They may be safe taking newer RCM Monitor carefully