围术期过敏反应(天津2013-7-14)课件.ppt

propofol-induced anaphylaxis Allergy Asthma Immunol Res.?2012 Jan;4(1):46-8. A case of propofol-induced oropharyngeal angioedema and bronchospasm. You BC,?Jang AS,?Han JS,?Cheon HW,?Park JS,?Lee JH,?Park SW,?Kim DJ,?Park CS. Korea. a 74-year-old woman who had an anaphylactic reaction with severe oropharyngeal edema and bronchospasm for a few minutes after receiving propofol during endoscopic examination. An allergy skin test was positive for both propofol and soybean. Soybean in the intralipid is one component of propofol, and we concluded that this anaphylaxis was caused by soybean. Quaternary ammonium ions (QAI) are proposed to be the allergenic epitopes in NMBAs. Common environmental chemicals such as toothpastes, washing detergents, shampoos, and cough medicines share these allergenic epitopes with the NMBAs [8]. Numerous possibilities exist for a predisposed individual to become sensitised to QAIs and thus be at risk of developing anaphylaxis to NMBAs during anaesthesia. A single muscle relaxant drug is somewhat difficult to use in screening programmes to detect individuals IgE-sensitized to QAI since considerable variations have been found in patients’ antibody reactivity to different drugs in the NMBA group. Morphine has an unusual alkaloid structure with only oneQAI epitope, which is actually a tertiary amine, and can therefore not by itself trigger mast cells or basophiles sensitized with IgE antibodies to QAI, but should have the potential to be used as a substitute for detection of an IgE-sensitization to QAI. Many regular household chemicals are known to carry branched amines, e.g. tertiary or quaternary amines (QAI). Presence of MOR and SUX reactivity, presumably allergenic, was studied using IgE antibody inhibition analyses. Of the 84 samples of environmental chemicals, 43 were positive in the MOR system and 34 in the SUX system. * Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS) and immunoblots were performed with cassava, avocado,