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Case Reports/Case Series: Kenneth C. Cummings, III and Katherina Arnaut Case report: Fentanyl-associated intraoperative anaphylaxis with pulmonary edema: [Étude de cas : Anaphylaxie peropératoire avec dème pulmonaire associé au fentanyl] Can J Anesth 2007; 54: 301-306 [Abstract] [Full text] [PDF]

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Anaphylaxis to opiods

subramanian sathishkumar   (19 April 2007)

Anaphylaxis to opiods 19 April 2007
subramanian sathishkumar, Anesthesiologist University of michigan, Ann arbor Send letter to journal: Re: Anaphylaxis to opiods ssathish{at}med.umich.edu subramanian sathishkumar	This case report adds a great value to the literature regarding anaphylaxis to opiods in particular.The incidence of anaphylaxis or anaphylactoid reactions to opiiods has been shown to be rare from a recent survey. I have come across a few times when patients gives history of allergy to fentanyl and most of times with no definitive evidence or skin testing to justify. This case report proves a point to be very careful and to give importance to patient history. It was interesting to note that mophine with more histamine releasing property was used uneventfully in this patient. The cross-reactivity of fentany with other opiods is rare and i guess ultra-short acting opiod like remifentanil metabolised by plasma esterases should be relatively safe for intraoperative period. If this patient had to have a general anesthetic and with the advice from allergist to avoid muscle relaxant, remifentanil would have been an useful alternative for intraoperative period. Morphine or a regional technique could have been used for postoperative analgesia.There are no case reports of anaphylactic reactions to opiods metabolised by non-specific plasma esterases.