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Anaphylactic shock following povidone

M A Gonzalo Garijo¹, J A Durán Quintana, P Bobadilla González

¹University Hospital Infanta Cristina, Badajoz, Spain.

The Annals of Pharmacotherapy

|January 1, 1996

Summary

Povidone, a common pharmaceutical excipient, caused a severe anaphylactic reaction in a patient. This highlights the importance of disclosing all ingredients in medications to prevent potential adverse drug events.

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Area of Science:

Pharmacology
Immunology
Allergy

Background:

Povidone is a widely used excipient in pharmaceuticals, food, and cosmetics.
While generally well-tolerated, povidone has been associated with local and systemic adverse effects.
The immunologic properties and potential for hypersensitivity reactions to povidone in humans require further investigation.

Observation:

A 37-year-old man with allergic rhinitis experienced anaphylaxis, including urticaria, dyspnea, and wheezing, post-intraarticular injection.
Provocation tests identified povidone, an excipient in the injected medication, as the cause of the reaction.
Tests for other components, including mepivacaine hydrochloride and other excipients like benzalkonium chloride and polysorbate 80, were negative.

Findings:

Povidone was confirmed as the causative agent of the severe anaphylactic reaction.
The exact immunologic mechanism, whether unspecific histamine release or IgE-mediated hypersensitivity, remains undetermined.
Povidone's immunogenicity and histamine-releasing capacity are known to be dose-dependent on its molecular weight.

Implications:

This case underscores the potential for excipients to cause significant iatrogenic adverse drug reactions.
Healthcare providers should consider excipients as potential allergens in patients presenting with unexplained anaphylaxis.
Full disclosure of pharmaceutical excipients is crucial for patient safety and accurate diagnosis of hypersensitivity reactions.

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