dc.contributor.author | Florvaag, E. | en_US |
dc.contributor.author | Johansson, S. G. O. | en_US |
dc.date.accessioned | 2014-10-27T14:12:58Z | |
dc.date.available | 2014-10-27T14:12:58Z | |
dc.date.issued | 2012-07-15 | eng |
dc.identifier.issn | 1939-4551 | |
dc.identifier.uri | https://hdl.handle.net/1956/8683 | |
dc.description.abstract | The Scandinavian data on pholcodine (PHO) strongly indicates that there is a biological chain from PHO exposure through IgE-sensitization to IgE-mediated anaphylaxis to neuromuscular blocking agents (NMBA). PHO is probably one of the strongest inducer of an IgE antibody response known. Of individuals taking PHO in cough medicines, over-the-counter accessibility to large populations, as many as 20 to 25% may become IgE sensitized. Once sensitized, PHO re-exposure will booster IgE antibody levels and IgE by around 100-fold. PHO is monovalent for 2 non-cross-reacting epitopes the quaternary ammonium ion (QAI), the main allergenic epitope of NMBA, and a non-QAI epitope. Thus, PHO most unlikely would initiate an allergic inflammatory response. Consequently, IgE sensitization is not revealed by obvious clinical signs, neither through tests based on IgE-sensitized effector cells. Therefore, it will escape detection if not assayed serologically. However, when subjected to general anesthesia, and thus the IgE-sensitized individual is administered a bivalent NMBA intravenously, the unrecognized presence of serum IgE antibodies to QAI may increase the risk of anaphylaxis 200- to 300-fold. Severe damages to patient's health can result, and mortality rates of 3 to 10% are reported. The Scandinavian experience indicates that the chain of events can efficiently be avoided by stopping PHO exposure: Within 1 year, the prevalence of IgE sensitization to PHO and QAI decreases significantly, and after 2 to 3 years, the numbers of reported anaphylactic reactions decreases equally so. | en_US |
dc.language.iso | eng | eng |
dc.publisher | BioMed Central | eng |
dc.rights | Attribution CC BY | eng |
dc.rights.uri | http://creativecommons.org/licenses/by/2.0 | eng |
dc.subject | Over-the-counter cough medicines | eng |
dc.subject | IgE antibodies | eng |
dc.subject | pholcodine | eng |
dc.subject | anaphylaxis | eng |
dc.title | The pholcodine Case. Cough Medicines, IgE-Sensitization, and Anaphylaxis: A Devious Connection | en_US |
dc.type | Peer reviewed | |
dc.type | Journal article | |
dc.date.updated | 2013-08-23T09:12:47Z | |
dc.description.version | publishedVersion | en_US |
dc.rights.holder | E Florvaag et al.; licensee BioMed Central Ltd. | |
dc.rights.holder | Copyright 2012 World Allergy Organization | |
dc.identifier.doi | https://doi.org/10.1097/wox.0b013e318261eccc | |
dc.source.journal | World Allergy Organization Journal | |
dc.source.40 | 5 | |
dc.source.pagenumber | 73-78 | |