1/5. in vitro drug allergy detection system incorporating human liver microsomes in chlorazepate-induced skin rash: drug-specific proliferation associated with interleukin-5 secretion.BACKGROUND: Chlorazepate is a benzodiazepine often used for pre-operative anxiolysis. The central metabolite responsible for the pharmacological and probably for the adverse effects of most benzodiazepines, including chlorazepate, is N-desmethyldiazepam. We report a woman who developed a generalized exanthem 1 day after receiving chlorazepate and four other drugs related to anaesthesia for surgery of the larynx. patch tests pointed to chlorazepate as the culprit drug for the skin rash. OBJECTIVES: The purpose of this study was to detect drug allergy to chlorazepate or a metabolite in vitro by means of the lymphocyte transformation test (LTT), and to determine the concentrations of the T-helper (Th) 2-type cytokine interleukin (IL)-5 and the Th1-type cytokine interferon (IFN) -gamma in the culture supernatants. methods: We performed an LTT with peripheral blood mononuclear cells from the patient and a control, employing human liver microsomes containing cytochrome P450 enzymes as a metabolizing system, in parallel cultures. IL-5 and IFN-gamma concentrations in the culture supernatants were assessed by enzyme-linked immunosorbent assay. RESULTS: In the LTT, no T-cell reactivity was observed to the parent compound chlorazepate, whereas coincubation of the drug with human liver microsomes yielded proliferative T-cell reactivity, which was associated with secretion of IL-5 but not of IFN-gamma. CONCLUSIONS: We conclude that addition of a metabolizing system may be advantageous for in vitro detection of T-cell reactivity to drug metabolites in the LTT.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/5. Anaphylactic shock following althesin. A case report.The authors present a case of anaphylactic shock in a 9-year-old girl with heamorrhagic rash developing during anaesthesia. shock was controlled with steroids, antihistamine drugs and dextran. The authors find it important to consider the possibility of the development of intravascular clotting in anaphylactic shock and the necessity of seeking a history of any allergy in patients before althesin anaesthesia.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
3/5. Anaphylactoid reaction to propofol.A case of an anaphylactoid reaction following the induction of anaesthesia is reported. Subsequent intradermal testing suggested propofol to be the causative agent.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/5. Anaphylactoid reaction following the use of etomidate.A 13-year-old female suffered urticaria and severe bronchospasm sufficient to cause hypoxic cardiac arrest after intravenous induction of anaesthesia. etomidate was strongly implicated in the reaction. The management and mechanism of the reaction are described and discussed, together with consideration of future anaesthesia in the patient.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
5/5. Fixed drug eruption associated with anaesthesia.We report the case of a 65-yr-old woman undergoing bronchoscopy for a lobular lesion who received thiopentone to induce anaesthesia that was maintained with sufentanil, vecuronium and isoflurane. She tolerated the procedure well initially, but developed eruptions about her face and fingers within 24 hr of anaesthesia. Treatment with flucinonide cream (0.05%) resolved the eruptions with no lasting sequelae. literature review supported the suspicion that the offending agent may have been thiopentone, so when a lobectomy was subsequently required and the patient refused investigation to identify the causative agent, propofol was employed as an alternative to induce anaesthesia. The surgery was well tolerated and the patient was discharged after an uneventful postoperative course. This case is reported to heighten awareness of the delayed onset of adverse effects which may be associated with the use of thiopentone.- - - - - - - - - - ranking = 7keywords = anaesthesia (Clic here for more details about this article) |