Non-IgE-Dependent Hypersensitivity to Rocuronium Reversed by Sugammadex: Report of Three Cases and Hypothesis on the Underlying Mechanism | Zendy

David Spoerl | Zendy; Stéphanie D''Incau | Zendy; Pascale RouxLombard | Zendy; Thomas Harr | Zendy; Christoph Czarnetzki | Zendy

Open Access

Non-IgE-Dependent Hypersensitivity to Rocuronium Reversed by Sugammadex: Report of Three Cases and Hypothesis on the Underlying Mechanism

Author(s) -

David Spoerl,

Stéphanie D''Incau,

Pascale RouxLombard,

Thomas Harr,

Christoph Czarnetzki

Publication year - 2016

Publication title -

international archives of allergy and immunology

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 0.696

H-Index - 100

eISSN - 1423-0097

pISSN - 1018-2438

DOI - 10.1159/000446182

Subject(s) - rocuronium , sugammadex , medicine , degranulation , immunoglobulin e , anaphylaxis , anesthesia , mast cell , allergy , hypersensitivity reaction , pharmacology , immunology , antibody , receptor , propofol

We present 3 cases of pseudoallergic (anaphylactoid) reactions to perioperatively administered rocuronium, which rapidly resolved after sugammadex injection. Allergological workup showed no evidence for immediate-type hypersensitivity to the drugs used for anesthesia, including rocuronium. However, rocuronium induced an irritative reaction in skin tests in all 3 patients and in 3 healthy individuals. This reaction was specifically suppressed by adding sugammadex at a 1:1 molecular proportion to rocuronium before the skin tests. This observation suggests that the patients suffered from a pseudoallergic reaction, and indicates that sugammadex might act via the inhibition of non-IgE mediated MRGPRX2 (Mas-related G-protein-coupled receptor member X2)-triggered mast cell degranulation induced by rocuronium.

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