Probable histamine liberation with atracurium. A case report

Area of Science:

• Anesthesiology
• Pharmacology
• Immunology

Background:

• Adverse drug reactions during anesthesia require careful investigation.
• Histaminoid reactions can mimic allergic responses.
• Distinguishing between histamine release and complement activation is crucial.

Observation:

• A patient exhibited a histaminoid reaction post-administration of thiopentone and atracurium.
• Serial blood samples did not indicate complement activation.
• Intradermal testing revealed a positive reaction to atracurium (1:1000 dilution) but not thiopentone.

Findings:

• The reaction was attributed to a direct pharmacological histamine liberation.
• Complement activation was ruled out as the underlying mechanism.
• Atracurium was identified as the likely trigger for histamine release.

Implications:

• This case highlights the potential for direct histamine release from atracurium.
• Understanding the mechanism of adverse reactions improves patient safety.
• Further research into non-allergic drug-induced histamine release is warranted.