Pseudoallergy

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Pseudoallergy

Pseudoallergy, sometimes known as nonallergic hypersensitivity, is a clinical mimic of immediate-type allergic reactions that lacks underlying immunological mechanisms. [1]

Contents

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), along with certain food ingredients and additives like tartrazine, benzoates, and salicylates, are the most common causes of pseudoallergic reactions. Since these reactions don't require IgE sensitization, they may manifest themselves after only one exposure. Doses-dependent, pseudoallergic reactions typically involve substances that are chemically unrelated. [2]

The lack of information in skin tests and serology makes the diagnosis challenging. Nonallergic hypersensitivity is diagnosed on the basis of a unique clinical pattern, clinical signs, time course, and response to cause elimination. Oral challenge tests can be used to confirm pseudoallergy in the proper clinical setting. [3]

Signs and symptoms

Clinically, pseudoallergy and anaphylaxis are identical. [4] Pseudoallergy symptoms include gastrointestinal symptoms, urticaria, bronchospasm, and angioedema, [5] along with headache, edema, skin flushing, hypotension, and shock. [6]

Causes

Although they are commonly used to treat pain related to fractures, opioid medications have well-known side effects. [7] Almost all opioids have the ability to directly induce mast cell degranulation, which in turn can result in pseudoallergy. [8] Opioid medications, including morphine, codeine, and meperidine, have been known to cause pseudoallergy. [9] By directly activating mast cells, opioids cause histamine release, which results in flushing or pruritus that is almost always mistaken for allergy symptoms. [10] Compared to other opioids, codeine and morphine have been shown to be more likely to cause mast cell degranulation. By using a non-immunologic mechanism that is not dependent on IgE or the high-affinity IgE receptor FcεRI, codeine causes pseudoallergy. [11] This suggests that codeine may activate mast cell degranulation by acting on the opioid receptor. [12]

Mechanism

While pseudoallergy and IgE-mediated allergy share some similarities in their clinical manifestations, [13] pseudoallergy is not the same as common allergy or type 1 reactions. [14] Pseudoallergy can be caused by a variety of medications through various pathways. For example, taxol can cause pseudoallergy by stimulating the complement system. The reaction occurs for the first time without any prior sensitization. [15]

See also

Related Research Articles

<span class="mw-page-title-main">Allergy</span> Immune system response to a substance that most people tolerate well

Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic dermatitis, allergic asthma, and anaphylaxis. Symptoms may include red eyes, an itchy rash, sneezing, coughing, a runny nose, shortness of breath, or swelling. Note that food intolerances and food poisoning are separate conditions.

<span class="mw-page-title-main">Anaphylaxis</span> Life-threatening allergic reaction

Anaphylaxis is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of use of emergency medication on site. It typically causes more than one of the following: an itchy rash, throat closing due to swelling that can obstruct or stop breathing; severe tongue swelling that can also interfere with or stop breathing; shortness of breath, vomiting, lightheadedness, loss of consciousness, low blood pressure, and medical shock. These symptoms typically start in minutes to hours and then increase very rapidly to life-threatening levels. Urgent medical treatment is required to prevent serious harm and death, even if the patient has used an epipen or has taken other medications in response, and even if symptoms appear to be improving.

<span class="mw-page-title-main">Mast cell</span> Cell found in connective tissue

A mast cell is a resident cell of connective tissue that contains many granules rich in histamine and heparin. Specifically, it is a type of granulocyte derived from the myeloid stem cell that is a part of the immune and neuroimmune systems. Mast cells were discovered by Paul Ehrlich in 1877. Although best known for their role in allergy and anaphylaxis, mast cells play an important protective role as well, being intimately involved in wound healing, angiogenesis, immune tolerance, defense against pathogens, and vascular permeability in brain tumors.

<span class="mw-page-title-main">Basophil</span> Type of white blood cell

Basophils are a type of white blood cell. Basophils are the least common type of granulocyte, representing about 0.5% to 1% of circulating white blood cells. However, they are the largest type of granulocyte and how they work is not fully understood. They are responsible for inflammatory reactions during immune response, as well as in the formation of acute and chronic allergic diseases, including anaphylaxis, asthma, atopic dermatitis and hay fever. They also produce compounds that coordinate immune responses, including histamine and serotonin that induce inflammation, and heparin that prevents blood clotting, although there are less than that found in mast cell granules. Mast cells were once thought to be basophils that migrated from the blood into their resident tissues, but they are now known to be different types of cells.

<span class="mw-page-title-main">Immunoglobulin E</span> Immunoglobulin E (IgE) Antibody

Immunoglobulin E (IgE) is a type of antibody that has been found only in mammals. IgE is synthesised by plasma cells. Monomers of IgE consist of two heavy chains and two light chains, with the ε chain containing four Ig-like constant domains (Cε1–Cε4). IgE is thought to be an important part of the immune response against infection by certain parasitic worms, including Schistosoma mansoni, Trichinella spiralis, and Fasciola hepatica. IgE is also utilized during immune defense against certain protozoan parasites such as Plasmodium falciparum. IgE may have evolved as a defense to protect against venoms.

<span class="mw-page-title-main">Rhinitis</span> Irritation and inflammation of the mucous membrane inside the nose

Rhinitis, also known as coryza, is irritation and inflammation of the mucous membrane inside the nose. Common symptoms are a stuffy nose, runny nose, sneezing, and post-nasal drip.

<span class="mw-page-title-main">Hives</span> Skin disease characterized by red, raised, and itchy bumps

Hives, also known as urticaria, is a kind of skin rash with red, raised, itchy bumps. Hives may burn or sting. The patches of rash may appear on different body parts, with variable duration from minutes to days, and does not leave any long-lasting skin change. Fewer than 5% of cases last for more than six weeks. The condition frequently recurs.

<span class="mw-page-title-main">Type I hypersensitivity</span> Type of allergic reaction

Type I hypersensitivity, in the Gell and Coombs classification of allergic reactions, is an allergic reaction provoked by re-exposure to a specific type of antigen referred to as an allergen. Type I is distinct from type II, type III and type IV hypersensitivities. The relevance of the Gell and Coombs classification of allergic reactions has been questioned in the modern-day understanding of allergy, and it has limited utility in clinical practice.

Omalizumab, sold under the brand name Xolair, is a medication to treat asthma, nasal polyps, and urticaria (hives).

<span class="mw-page-title-main">Ketotifen</span> Antihistamine medication

Ketotifen is an antihistamine medication and a mast cell stabilizer commonly used to treat allergic conditions such as conjunctivitis, asthma, and urticaria (hives). Ketotifen is available in ophthalmic and oral forms: the ophthalmic form relieves eye itchiness and irritation associated with seasonal allergies, while the oral form helps prevent systemic conditions such as asthma attacks and allergic reactions. In addition to treating allergies, ketotifen has shown efficacy in managing systemic mast cell diseases such as mastocytosis and mast cell activation syndrome (MCAS), which involve abnormal accumulation or activation of mast cells throughout the body. Ketotifen is also used for other allergic-type conditions like atopic dermatitis (eczema) and food allergies.

A drug allergy is an allergy to a drug, most commonly a medication, and is a form of adverse drug reaction. Medical attention should be sought immediately if an allergic reaction is suspected.

Autoimmune progesterone dermatitis(APD) occurs during the luteal phase of a woman's menstrual cycle and is an uncommon cyclic premenstrual reaction to progesterone. It can present itself in several ways, including eczema, erythema multiforme, urticaria, angioedema, and progesterone-induced anaphylaxis. The first case of autoimmune progesterone dermatitis was identified in 1964. Reproductive function may be impacted by APD.

One of the most prevalent forms of adverse drug reactions is cutaneous reactions, with drug-induced urticaria ranking as the second most common type, preceded by drug-induced exanthems. Urticaria, commonly known as hives, manifests as weals, itching, burning, redness, swelling, and angioedema—a rapid swelling of lower skin layers, often more painful than pruritic. These symptoms may occur concurrently, successively, or independently. Typically, when a drug triggers urticaria, symptoms manifest within 24 hours of ingestion, aiding in the identification of the causative agent. Urticaria symptoms usually subside within 1–24 hours, while angioedema may take up to 72 hours to resolve completely.

Adrenergic urticaria is a skin condition characterized by an eruption consisting of small (1-5mm) red macules and papules with a pale halo, appearing within 10 to 15 min after emotional upset. There have been 10 cases described in medical literature, and involve a trigger followed by a rise in catecholamine and IgE. Treatment involves propranolol and trigger avoidance.

<span class="mw-page-title-main">Chronic spontaneous urticaria</span> Medical condition

Chronic spontaneous urticaria(CSU) also known as Chronic idiopathic urticaria(CIU) is defined by the presence of wheals, angioedema, or both for more than six weeks. Chronic spontaneous urticaria can be characterized by angioedema, excruciatingly itchy recurrent hives, or both. Chronic urticaria patients were found to have a higher prevalence of various autoimmune diseases. Many patients with chronic spontaneous urticaria report that certain triggers, such as stress, infections, specific foods, or nonsteroidal anti-inflammatory drug use, aggravate their condition.

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<span class="mw-page-title-main">Autoimmune urticaria</span> Autoimmune disease causing hives and itching

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References

  1. ↑ Zuberbier, Torsten (2001). "The Role of Allergens and Pseudoallergens in Urticaria". Journal of Investigative Dermatology Symposium Proceedings. Elsevier BV. 6 (2): 132–134. doi: 10.1046/j.0022-202x.2001.00024.x . ISSN   1087-0024. PMID   11764298.
  2. ↑ Grattan, Clive E.H.; Borzova, Elena (2019). "Urticaria, Angioedema, and Anaphylaxis". Clinical Immunology. Elsevier. pp. 585–600.e1. doi:10.1016/b978-0-7020-6896-6.00042-9. ISBN   978-0-7020-6896-6.
  3. ↑ Reese, Imke; Zuberbier, Torsten; Bunselmeyer, Britta; Erdmann, Stephan; Henzgen, Margot; Fuchs, Thomas; Jäger, Lothar; Kleine‐Tebbe, Jörg; Lepp, Ute; Niggemann, Bodo; Raithel, Martin; Saloga, Joachim; Vieths, Stephan; Werfel, Thomas (2009). "Diagnostic approach for suspected pseudoallergic reaction to food ingredients". JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 7 (1): 70–77. doi:10.1111/j.1610-0387.2008.06894.x. ISSN   1610-0379. PMID   19054425. S2CID   23773448.
  4. ↑ He, Shao-heng; Zhang, Hui-yun; Zeng, Xiao-ning; Chen, Dong; Yang, Ping-chang (August 26, 2013). "Mast cells and basophils are essential for allergies: mechanisms of allergic inflammation and a proposed procedure for diagnosis". Acta Pharmacologica Sinica. Springer Science and Business Media LLC. 34 (10): 1270–1283. doi:10.1038/aps.2013.88. ISSN   1671-4083. PMC   4002163 . PMID   23974516.
  5. ↑ Toncić, Ruzica Jurakić; Marinović, Branka; Lipozencić, Jasna (2009). "Nonallergic hypersensitivity to nonsteroidal antiinflammatory drugs, angiotensin-converting enzyme inhibitors, radiocontrast media, local anesthetics, volume substitutes and medications used in general anesthesia". Acta Dermatovenerologica Croatica. 17 (1): 54–69. PMID   19386216.
  6. ↑ Wang, Zhiguo; Wang, Danqiao; Sui, Yu; Cui, Haifeng; Yu, Youhua (2012). "Experimental study on anaphylaxis of Qingkailing injection and its components on Beagle dogs". Journal of Traditional Chinese Medicine. Elsevier BV. 32 (4): 641–645. doi: 10.1016/s0254-6272(13)60085-0 . ISSN   0254-6272. PMID   23427403.
  7. ↑ Baker, Mark D.; Gullett, John P. (2015). "Ultrasound-Guided Femoral Nerve Blocks". Pediatric Emergency Care. Ovid Technologies (Wolters Kluwer Health). 31 (12): 864–868. doi:10.1097/pec.0000000000000634. ISSN   0749-5161. PMID   26626896. S2CID   5150857.
  8. ↑ Becker, Daniel E. (December 1, 2013). "Drug Allergies and Implications for Dental Practice". Anesthesia Progress. American Dental Society of Anesthesiology (ADSA). 60 (4): 188–197. doi:10.2344/0003-3006-60.4.188. ISSN   0003-3006. PMC   3891459 . PMID   24423421.
  9. ↑ Wang, Hong (2011). "Agents that induce pseudo-allergic reaction". Drug Discoveries & Therapeutics. International Research and Cooperation Association for Bio & Socio-Sciences Advancement (IRCA-BSSA). 5 (5): 211–219. doi: 10.5582/ddt.2011.v5.5.211 . ISSN   1881-7831. PMID   22466368.
  10. ↑ "1868-2020: Supporting general practitioners for more than 150 years". The Practitioner. September 24, 2015. Retrieved December 20, 2023.
  11. ↑ Yoo, Hye-Soo; Yang, Eun-Mi; Kim, Mi-Ae; Hwang, Sun-Hyuk; Shin, Yoo-Seob; Ye, Young-Min; Nahm, Dong-Ho; Park, Hae-Sim (2014). "A Case of Codeine Induced Anaphylaxis via Oral Route". Allergy, Asthma & Immunology Research. The Korean Academy of Asthma, Allergy and Clinical Immunology and The Korean Academy of Pediatric Al. 6 (1): 95. doi:10.4168/aair.2014.6.1.95. ISSN   2092-7355. PMC   3881408 .
  12. ↑ Sheen, C. H.; Schleimer, R. P.; Kulka, M. (April 12, 2007). "Codeine induces human mast cell chemokine and cytokine production: involvement of G‐protein activation". Allergy. Wiley. 62 (5): 532–538. doi:10.1111/j.1398-9995.2007.01345.x. ISSN   0105-4538. PMC   2199376 . PMID   17441793.
  13. ↑ Ring, J; Messmer, K (1977). "Incidence and Severity of Anaphylactoid Reactions to Colloid Volume Substitutes". The Lancet. Elsevier BV. 309 (8009): 466–469. doi:10.1016/s0140-6736(77)91953-5. ISSN   0140-6736. S2CID   37201704.
  14. ↑ Zhang, Bo; Li, Qin; Shi, Chenyang; Zhang, Xinyue (November 15, 2017). "Drug-Induced Pseudoallergy: A Review of the Causes and Mechanisms". Pharmacology. S. Karger AG. 101 (1–2): 104–110. doi: 10.1159/000479878 . ISSN   0031-7012. PMID   29136631.
  15. ↑ Szebeni, Janos; Alving, Carl R.; Savay, Sandor; Barenholz, Yechezkel; Priev, Aba; Danino, Dganit; Talmon, Yeshayahu (2001). "Formation of complement-activating particles in aqueous solutions of Taxol: possible role in hypersensitivity reactions". International Immunopharmacology. Elsevier BV. 1 (4): 721–735. doi:10.1016/s1567-5769(01)00006-6. ISSN   1567-5769. PMID   11357884.

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