Related Experiment Video
Updated: May 13, 2026
04:58
Collecting And Measuring Wound Exudate Biochemical Mediators In Surgical Wounds
Published on: October 20, 2012
[Correlation between pholcodine and perioperative anaphylaxis]
Jelena Dumancić1, Asja Stipić Marković
1Department of Clinical Immunology, Pulmonology and Rheumatology, University Department of Internal Medicine, Sveti Duh University Hospital, Zagreb, Croatia. jdumancic@gmail.com
Acta Medica Croatica : Casopis Hravatske Akademije Medicinskih Znanosti
|February 27, 2013
Summary
Pholcodine, a common cough medicine, can cause severe allergic reactions (anaphylaxis) to muscle relaxants due to shared ammonium ions. Removing pholcodine reduced these reactions in Norway.
Area of Science:
- Pharmacology
- Immunology
- Clinical Medicine
Background:
- Anaphylactic reactions to neuromuscular blocking agents (NMBAs) occur in patients with no prior exposure.
- Pholcodine, a widely used cough suppressant in Europe, has been identified as a potential sensitizing agent.
- Cross-reactivity between pholcodine and NMBAs is linked to a common ammonium ion epitope.
Purpose of the Study:
- To investigate the role of pholcodine in sensitization to neuromuscular blocking agents.
- To understand the mechanism of cross-reactivity between pholcodine and NMBAs.
- To evaluate the impact of pholcodine withdrawal on anaphylaxis rates.
Main Methods:
- Review of published studies linking pholcodine use to perioperative anaphylaxis.
- Analysis of anaphylaxis rates before and after pholcodine withdrawal in Norway.
- Examination of the immunological basis for cross-reactivity (ammonium ion epitope).
Main Results:
- Studies indicated a connection between pholcodine use and perioperative anaphylactic reactions.
- Withdrawal of pholcodine from the Norwegian market was followed by a reduction in anaphylactic reactions.
- The ammonium ion was identified as the common epitope responsible for cross-reactivity.
Conclusions:
- Pholcodine is implicated as a sensitizing agent for neuromuscular blocking agents.
- The common ammonium ion epitope explains the observed cross-reactivity.
- Market withdrawal of pholcodine led to decreased anaphylaxis rates, supporting its role.
Related Concept Videos
01:24Parenteral Anesthetics: Overview
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
01:30Allergic Reactions: Anaphylaxis
Anaphylaxis is a severe, life-threatening hypersensitivity reaction mediated by Immunoglobulin E (IgE) antibodies. When IgE binds to allergens, it triggers the release of mediators– histamine, leukotrienes, and prostaglandins from mast cells and basophils. These mediators cause vasodilation, edema, and inflammation, leading to various symptoms.The primary allergens causing anaphylaxis include food items (e.g., peanuts, shellfish), drugs (e.g., penicillin, asparaginase, corticotropin, heparin),...
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
01:13Local Anesthetics: Pharmacokinetics
The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
01:12Local Anesthetics: Adverse Effects
While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
01:26Pharmaceutical Poisoning: Potential Scenarios
Pharmaceutical poisoning can occur through various channels, impacting an estimated 2 million hospitalized patients in the U.S. annually with serious adverse drug responses. These scenarios encompass both therapeutic uses, such as drug toxicity, where even standard dosages can lead to severe central nervous system depression, and non-therapeutic exposures, including accidental ingestion by children, and environmental and occupational exposures.Unintentional poisonings often involve exploratory...