Journal article
Exploring the link between pholcodine exposure and neuromuscular blocking agent anaphylaxis
British Journal of Clinical Pharmacology, Vol.78(7), pp.14-23
2014
Abstract
Neuromuscular blocking agents (NMBAs) are the most commonly implicated drugs in IgE-mediated anaphylaxis during anaesthesia that can lead to perioperative morbidity and mortality. The rate of NMBA anaphylaxis shows marked geographical variation in patients who have had no known prior exposure to NMBAs, suggesting that there may be external or environmental factors that contribute to the underlying aetiology and pathophysiology of reactions. Substituted ammonium ions are shared among NMBAs and are therefore thought to be the main allergenic determinant of this class of drugs. Substituted ammonium ions are found in a wide variety of chemical structures, including prescription medications, over-the-counter medications and common household chemicals, such as the quaternary ammonium disinfectants. Epidemiological studies have shown parallels in the consumption of pholcodine, a nonprescription antitussive drug which contains a tertiary ammonium ion, and the incidence of NMBA anaphylaxis. This link has prompted the withdrawal of pholcodine in some countries, with an ensuing fall in the observed rate of NMBA anaphylaxis. While such observations are compelling in their suggestion of a relationship between pholcodine exposure and NMBA hypersensitivity, important questions remain regarding the mechanisms by which pholcodine is able to sensitize against NMBAs and whether there are other, as yet unidentified, agents that can elicit similar hypersensitivity reactions. This review aims to explore the evidence linking pholcodine exposure to NMBA hypersensitivity and discuss the implications for our understanding of the pathophysiology of these reactions.
Details
- Title
- Exploring the link between pholcodine exposure and neuromuscular blocking agent anaphylaxis
- Authors/Creators
- A.M. Brusch (Author/Creator) - Fremantle HospitalR.C. Clarke (Author/Creator) - Sir Charles Gairdner HospitalP.R. Platt (Author/Creator) - Sir Charles Gairdner HospitalE.J. Phillips (Author/Creator) - Murdoch University
- Publication Details
- British Journal of Clinical Pharmacology, Vol.78(7), pp.14-23
- Publisher
- Wiley
- Identifiers
- 991005543049007891
- Copyright
- © 2013 The British Pharmacological Society.
- Murdoch Affiliation
- Institute for Immunology and Infectious Diseases
- Language
- English
- Resource Type
- Journal article
UN Sustainable Development Goals (SDGs)
This output has contributed to the advancement of the following goals:
Source: InCites
Metrics
75 Record Views
InCites Highlights
These are selected metrics from InCites Benchmarking & Analytics tool, related to this output
- Collaboration types
- Domestic collaboration
- International collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.65 Allergy
- 1.65.264 Allergy Mechanisms
- Web Of Science research areas
- Pharmacology & Pharmacy
- ESI research areas
- Pharmacology & Toxicology