Morphine-specific IgE testing in the assessment of neuromuscular blocking agent allergy: a single centre experience

Editor—Neuromuscular blocking agents (NMBAs) are a frequent cause of perioperative reactions. 1 Volcheck G.W. Hepner D.L. Identification and management of peri-operative anaphulaxis. J Allergy Clin Immunol Pract. 2019; 7: 2134-2142 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar In 1983, Baldo & Fisher 2 Baldo B.A. Fisher M.M. Substituted ammonium ions as allergenic determinants in drug allergy. Nature. 1983; 306: 262-264 Crossref PubMed Scopus (245) Google Scholar identified the allergenic site of alcuronium as the substituted tertiary or quaternary ammonium ions, also present in other NMBAs, morphine, and later also demonstrated in pholcodine. 2 Baldo B.A. Fisher M.M. Substituted ammonium ions as allergenic determinants in drug allergy. Nature. 1983; 306: 262-264 Crossref PubMed Scopus (245) Google Scholar ,3 Florvaag E. Johansson G.O. Oman H. et al. Prevalence of IgE antibodies to morphine. Relation to the high and low incidences of NMBA anaphylaxis in Norway and Sweden, respectively. Acta Anaesthesiol Scand. 2005; 49: 437-444 Crossref PubMed Scopus (141) Google Scholar They reported that morphine-specific immunoglobulin E (sIgE) determined by radioimmunoassay (RIA) was superior to specific NMBA-IgE RIA, suggesting that morphine-sIgE be routinely implemented in the assessment of NMBA anaphylaxis. 4 Fisher M.M. Baldo B.A. Immunoassays in the diagnosis of anaphylaxis to neuromuscular blocking drugs: the value of morphine for the detection of IgE antibodies in allergic subjects. Anaesth Intensive Care. 2000; 28: 167-170 Crossref PubMed Google Scholar