PMID- 17983379
OWN - NLM
STAT- MEDLINE
DCOM- 20080122
LR  - 20231024
IS  - 0105-4538 (Print)
IS  - 0105-4538 (Linking)
VI  - 62
IP  - 12
DP  - 2007 Dec
TI  - Pholcodine exposure raises serum IgE in patients with previous anaphylaxis to 
      neuromuscular blocking agents.
PG  - 1445-50
AB  - BACKGROUND: Neuromuscular blocking agents (NMBAs) can cause anaphylaxis through 
      immunoglobulin E (IgE) antibodies that bind quaternary ammonium ion epitopes. 
      These epitopes are present in numerous common chemicals and drugs, exposure to 
      which, theoretically, could be of importance in the development and maintenance 
      of the IgE sensitization promoting allergic reactions. Pholcodine is one such 
      drug, which in a recent pilot study was shown to induce a remarkable increase in 
      serum IgE levels in two IgE-sensitized individuals. The present study explores 
      the effect of pholcodine exposure on IgE in a population with previously 
      diagnosed IgE-mediated anaphylaxis towards NMBAs. METHODS: Seventeen patients 
      were randomized to 1 week's exposure with cough syrup containing either 
      pholcodine or guaifenesin. The primary variables serum IgE and IgE antibodies 
      towards pholcodine, morphine and suxamethonium were measured before and 4 and 8 
      weeks after start of exposure. RESULTS: Patients exposed to pholcodine had a 
      sharp rise in levels of IgE antibodies towards pholcodine, morphine and 
      suxamethonium, the median proportional increases 4 weeks after exposure reaching 
      39.0, 38.6 and 93.0 times that of the base levels respectively. Median 
      proportional increase of IgE was 19.0. No changes were observed in the 
      guaifenesin group. CONCLUSION: Serum levels of IgE antibodies associated with 
      allergy towards NMBAs increase significantly in sensitized patients after 
      exposure to cough syrup containing pholcodine. Availability of pholcodine should 
      be restricted by medical authorities because of the potential risk of future 
      allergic reactions to muscle relaxants.
FAU - Harboe, T
AU  - Harboe T
AD  - Department of Anaesthesia and Intensive Care, Haukeland University Hospital, 
      Bergen, Norway.
FAU - Johansson, S G O
AU  - Johansson SG
FAU - Florvaag, E
AU  - Florvaag E
FAU - Oman, H
AU  - Oman H
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - Denmark
TA  - Allergy
JT  - Allergy
JID - 7804028
RN  - 0 (Allergens)
RN  - 0 (Antitussive Agents)
RN  - 0 (Morpholines)
RN  - 0 (Neuromuscular Blocking Agents)
RN  - 37341-29-0 (Immunoglobulin E)
RN  - 76I7G6D29C (Morphine)
RN  - J2R869A8YF (Succinylcholine)
RN  - LPP64AWZ7L (pholcodine)
RN  - UX6OWY2V7J (Codeine)
SB  - IM
MH  - Adult
MH  - Allergens/adverse effects/immunology
MH  - Anaphylaxis/*chemically induced/immunology
MH  - Antitussive Agents/administration & dosage/adverse effects/*immunology
MH  - Codeine/administration & dosage/adverse effects/*analogs & derivatives/immunology
MH  - Female
MH  - Humans
MH  - Hypersensitivity, Immediate/chemically induced/*immunology
MH  - Immunoglobulin E/analysis/*blood
MH  - Male
MH  - Middle Aged
MH  - Morphine/adverse effects/immunology
MH  - Morpholines/administration & dosage/adverse effects/*immunology
MH  - Neuromuscular Blocking Agents/*adverse effects
MH  - Skin Tests
MH  - Succinylcholine/adverse effects/immunology
MH  - Treatment Outcome
EDAT- 2007/11/07 09:00
MHDA- 2008/01/23 09:00
CRDT- 2007/11/07 09:00
PHST- 2007/11/07 09:00 [pubmed]
PHST- 2008/01/23 09:00 [medline]
PHST- 2007/11/07 09:00 [entrez]
AID - ALL1554 [pii]
AID - 10.1111/j.1398-9995.2007.01554.x [doi]
PST - ppublish
SO  - Allergy. 2007 Dec;62(12):1445-50. doi: 10.1111/j.1398-9995.2007.01554.x.