Anaphylaxis due to succinylcholine. Immunoallergological study of thirteen cases

The antigen non-specific release of histamine by synthetic neuromuscular blocking agents is well known, though our review of thirty-two cases reported in the literature of anaphylactoid reactions to succinylcholine, shows that there is insufficient evidence to determine whether the signs are due to anaphylactic or to anaphylactoid reactions. We have examined thirteen cases in whom evidence of anaphylactic sensitization was examined by direct skin tests (in eleven cases) Prausnitz--Küstner tests (in five), rabbit basophil degranulation, Shelley test (in twelve) and human basophil degranulation (in seven). These tests were done on two to four occasions, and the optimal period for the first test ascertained to be 6 to 12 weeks after the episode. All eleven patients examined by direct skin tests showed evidence of anaphylactic sensitivity, and in three of five cases the sensitivity could be transferred by the Prausnitz--Küstner procedure. In one of these P--K tests there was evidence of both IgE and of IgG S-TS antibodies (heat-stable antibody conferring sensitivity for 2 hr). Particular susceptibilities to adverse reactions of this drug appear to be prior drug allergy (in 50% of cases), several previous anaesthetics, and atopy.