![]() Patients who developed an IMR after receiving an opioid from a different class than the opioid previously documented as H-IMR were considered to be cross-reactive. Newly suspected IgE-mediated reactions were defined based on the following criteria immediately after opioid administration: the appearance of rash, urticaria, pruritus, or throat swelling or the requirement of treatment with epinephrine, diphenhydramine, or steroids or a new ICD-9 code for anaphylaxis. Patients' electronic healthcare records were retrospectively reviewed to identify historically documented opioid allergyĪnd then classify as a possible historical IgE-mediated reaction (H-IMR) or an intolerance reaction based on temporal association and symptomatic presentation. Pregnancy prisoners cognitively challenged patients patients receiving concomitant nonopioid medications for which they had a documented allergy patients admitted for the primary diagnosis of anaphylaxis, angioedema, or any other allergic condition Patients aged 18 to 89 years who self-reported or had a chart documented history of an opioid allergy on admission and subsequently received an opioid medication during their stay Historical IgE-mediated reaction (H-IMR n= 212) ![]() ![]() To characterize the incidence of newly suspected IgE-mediated reactions (IMRs) based on clinical criteria among patients with a chart-documented opioid allergy and to assess clinician perceptions of opioid allergies Single-center, retrospective cohort study doi:10.1007/s00208-2Īssessment of Opioid Cross-reactivity and Provider Perceptions in Hospitalized Patients With Reported Opioid Allergies Toxicities of opioid analgesics: respiratory depression, histamine release, hemodynamic changes, hypersensitivity, serotonin toxicity. Assessment of Opioid Cross-reactivity and Provider Perceptions in Hospitalized Patients With Reported Opioid Allergies. The cross-reactivity of various opioids with tramadol is not discussed. However, there have been reports of skin reactions such as urticaria and rashes, but these are noted to be relatively uncommon. Īccording to a 2021 review, hypersensitivity reactions to tramadol are rare as are non-immune anaphylactoid responses. This was noted to be the first study to systematically characterize opioid cross-reactivity rates comprehensively in a clinical setting. In this study, 7.9% of patients who were administered a synthetic opioid (e.g., tramadol) after a documented historical IMR to a semisynthetic opioid (e.g., hydrocodone) experienced an IMR (see Table 2). Due to the limited data assessing cross-reactivity between opioids, a retrospective cohort study was conducted to determine the incidence of IMRs among patients with a chart-documented opioid allergy who were rechallenged with opioid therapy for the management of pain. For this reason, allergic cross-sensitivity between opioid classes may theoretically occur based on molecular structure however, cross-sensitivity between opioid classes is not well defined. Opioids are often classified by their molecular structure and possess similar histamine-releasing properties, adverse effect profiles, and potential for IgE-binding inhibition as other opioids within the same class (see Table 1). Many opioids can cause mast cell degranulation and subsequent histamine release independent of IgE antibodies, which can lead to reactions mimicking an IgE-mediated reaction (IMR).
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