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Updated: Jul 19, 2026
08:05
Murine Model of Allergen Induced Asthma
Published on: May 14, 2012
Pharmacological stimuli in asthma/urticaria.
L Prieto-Lastra1, A Iglesias-Cadarso, M M Reaño-Martos
1Allergy Service, Universitary Hospital Puerta de Hierro, Madrid. Spain. 652652167@amena.com
Allergologia Et Immunopathologia
|October 27, 2006
Summary
Opioid analgesics like codeine can trigger urticaria and bronchospasm. Non-histamine-releasing opioids such as tramadol are safer alternatives for patients with asthma or urticaria.
Area of Science:
- Pharmacology
- Allergology
- Clinical Medicine
Background:
- Opioid analgesics are increasingly used, posing risks for patients with urticaria and asthma due to potential adverse reactions.
- Codeine, morphine, and pethidine are known histamine-releasing agents, potentially exacerbating conditions like urticaria and asthma.
- Adverse reactions to opioids can manifest as cutaneous symptoms (urticaria) or respiratory distress (bronchospasm).
Observation:
- Three patients experienced allergic reactions to codeine, including acute urticaria and bronchospasm.
- Skin prick tests (SPT) and intradermal reactions (IDR) showed similar results in patients and controls, indicating limited diagnostic value for IgE-mediated reactions.
- Controlled oral challenges confirmed codeine-induced bronchospasm and urticaria, while tramadol was tolerated well by all patients.
Findings:
- Opioid-induced hypersensitivity reactions are often not IgE-mediated, rendering standard allergy tests less reliable.
- Histamine-releasing potential varies among opioids; codeine, morphine, and pethidine are high-releasers, whereas tramadol, fentanyl, and remifentanil are non-releasers.
- Cutaneous reactions are more common than respiratory reactions due to mast cell distribution.
Implications:
- Tramadol, fentanyl, and remifentanil are recommended for pain management in patients with pulmonary conditions or a history of opioid-induced hypersensitivity.
- Controlled oral challenges are crucial for diagnosing opioid hypersensitivity when standard allergy tests are inconclusive.
- Understanding opioid pharmacology, particularly histamine-releasing properties, is vital for safe analgesic selection in susceptible patients.
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