succinylcholine allergy

Succinylcholine, also known as suxamethonium chloride, is a medication used to induce muscle relaxation during surgical procedures. However, it can cause severe allergic reactions in some individuals.

Symptoms of Succinylcholine Allergy

The symptoms of succinylcholine allergy can be life-threatening and require immediate medical attention. They include:

• Anaphylaxis: A severe, whole-body allergic reaction that can cause difficulty breathing, rapid heartbeat, and a drop in blood pressure.
• Muscle relaxation or paralysis that lasts several hours longer than expected
• Skeletal muscle weakness
• Decreased muscle tone
• Increased intraocular pressure

Causes of Succinylcholine Allergy

The exact causes of succinylcholine allergy are not fully understood, but it is believed to be related to the body's immune response to the medication. Some individuals may be more susceptible to developing an allergy due to their genetic predisposition or previous exposure to similar medications.

Precautions and Warnings

To avoid severe allergic reactions, healthcare providers should take the following precautions:

• Conduct thorough medical histories to identify patients with a history of allergies or sensitivities
• Monitor patients closely during and after administration of succinylcholine for signs of anaphylaxis or other adverse reactions
• Be aware of the potential for increased intraocular pressure and take necessary precautions

References

1. Succinylcholine may induce some severe adverse reactions, such as anaphylactic shock [1].
2. Signs and symptoms of pseudocholinesterase deficiency include muscle relaxation or paralysis that lasts several hours longer than expected [2].
3. Anaphylaxis seems to be more common with rocuronium and succinylcholine [3].
4. Severe allergic reactions (anaphylaxis) are a known risk associated with succinylcholine use [4].
5. Symptoms of succinylcholine allergy can include skeletal muscle weakness, decreased muscle tone, and increased intraocular pressure [5].
6. Succinylcholine causes an increase in intraocular pressure, which should be taken into consideration when administering the medication [6].
7. Known hypersensitivity to succinylcholine is a contraindication for its use [7].

References: [1] M Le Dorze · 2017 [2] [3] Dec 13, 2022 [4] [5] Jan 31, 2024 [6] [7]

Based on the provided context, here are the signs and symptoms of succinylcholine allergy:

• Muscle relaxation or muscle paralysis that lasts several hours longer than expected [1]
• Twitching
• Change in eyesight or eye pain
• Fast heartbeat
• Fast breathing
• Fever
• Spasm or stiffness of the jaw muscles
• Signs of an allergic reaction, such as:
  • Rash
  • Hives
  • Itching
  • Red, swollen, blistered, or peeling skin with or without fever [3]
  • Wheezing
  • Tightness in the chest or throat

Additionally, other symptoms that may be related to a succinylcholine allergy include:

• Chest tightness
• Cough
• Difficulty swallowing
• Dizziness
• Hives
• Itching
• Low blood pressure (hypotension)
• Muscle fasciculation
• Skeletal muscle weakness
• Decreased respiratory reserve
• Low tidal volume
• Cessation of breathing

Diagnosing Succinylcholine Allergy

Succinylcholine, a muscle relaxant used in anesthesia, can cause an allergic reaction in some individuals. Diagnosing this allergy requires a combination of clinical evaluation and laboratory tests.

• Clinical Evaluation: The first step in diagnosing succinylcholine allergy is to assess the patient's medical history and symptoms. A thorough examination by a healthcare professional is essential to determine if the patient has experienced an allergic reaction to succinylcholine in the past [1].
• Skin Tests: Skin tests, such as epicutaneous prick testing, are commonly used to diagnose drug hypersensitivity reactions caused by succinylcholine [6]. These tests involve applying a small amount of the allergen to the skin and observing for any reaction.
• Blood Tests: Blood tests can also be used to diagnose succinylcholine allergy. A pseudocholinesterase enzyme activity test can help determine if the patient has inherited pseudocholinesterase deficiency, which can increase the risk of succinylcholine-induced anaphylaxis [2].
• Cholinesterase Tests: Cholinesterase tests measure the activity of enzymes involved in transmitting nerve impulses. Acetylcholinesterase is one such enzyme that can be affected by succinylcholine use [3].

Diagnostic Methods

The gold standard for diagnosing drug hypersensitivity reactions, including those caused by succinylcholine, involves a combination of clinical evaluation and laboratory tests. The following methods are commonly used:

• Epicutaneous Prick Testing: This is the main diagnostic method for evaluating drug hypersensitivity reactions [7].
• In Vitro Allergy Diagnostics: These tests use whole allergens and allergen mixes to diagnose allergies, including those caused by succinylcholine [8].

References

[1] M Le Dorze (2017) - Patient history, clinical symptoms, histamine and tryptase measurements, IgE-specific assays, and skin tests are the gold standard for diagnosing anaphylactic reactions.

[2] A blood test can tell if you have enough of the pseudocholinesterase enzyme. To diagnose inherited pseudocholinesterase deficiency, the gene change that causes this condition is identified.

[3] Cholinesterase tests measure the activity of these enzymes. Acetylcholinesterase is involved in transmission of nerve impulses by breaking down acetylcholine.

[4] To confirm your diagnosis, they can run a blood test to check your pseudocholinesterase enzyme levels.

[5] Pseudocholinesterase deficiency is diagnosed by plasma assays of pseudocholinesterase enzyme activity.

[6] Both European and American guidelines currently recommend using skin tests as the main diagnostic method for evaluating drug hypersensitivity reactions caused by succinylcholine.

[7] The clinician should start with epicutaneous prick testing. If results are negative after 15 to 20 minutes have elapsed, one should proceed next to IDT.

[8] The gold standard in in-vitro allergy diagnostics with more than 500 whole allergens and allergen mixes.

Note: Pseudocholinesterase deficiency is a rare disorder that makes you sensitive to certain muscle relaxants — succinylcholine or mivacurium.

Treatment Options for Succinylcholine Allergy

Succinylcholine, a muscle relaxant used during general anesthesia, can cause anaphylaxis in some individuals. When this occurs, prompt treatment is essential to prevent serious complications.

• Epinephrine: The recommended first-line therapy drug for treating anaphylaxis caused by succinylcholine is epinephrine [1]. However, the difficulty of diagnosing perianaesthetic anaphylaxis may lead to suboptimal and/or delayed use of this medication.
• Mechanical Ventilatory Support: In cases where respiratory muscle paralysis persists, mechanical ventilatory support becomes the mainstay of treatment until spontaneous resolution occurs [7].
• Sugammadex: This drug has been proposed as a potential treatment for anaphylaxis to rocuronium and may also improve recovery in such cases. However, its ability to play a role in reaction reversal is still being researched [10].

Precautions and Considerations

When using succinylcholine, healthcare providers must exercise caution in patients with reduced plasma cholinesterase (pseudocholinesterase) activity, as this can increase sensitivity to the drug [9]. Additionally, there is no cure for pseudocholinesterase deficiency, but alternative muscle relaxants can be used under medical supervision.

References

[1] M Le Dorze et al. (2017). The difficulty of diagnosing perianaesthetic anaphylaxis probably led to suboptimal and/or delayed use of epinephrine, the recommended first-line therapy drug.

[7] ER Kepes (1959). Since 1950 succinylcholine has had extensive clinical trial and has been administered to thousands of patients to produce muscular relaxation for surgery.

[9] PM Mertes (2015). Sugammadex has also recently been proposed to improve recovery in case of anaphylaxis to rocuronium18; however, its ability to play a role in reaction reversal is still being researched.

The differential diagnosis of succinylcholine allergy involves considering various conditions that can mimic or be confused with an allergic reaction to this medication.

According to the search results, intraoperative anaphylactic reactions may range from mild, erythema-like to anaphylactic shock, with tension crash and bronchospasm [14]. This highlights the importance of a thorough differential diagnosis in such cases.

Some conditions that can be considered in the differential diagnosis of succinylcholine allergy include:

• Pseudocholinesterase deficiency: This is a condition where the enzyme pseudocholinesterase is deficient or absent, leading to prolonged paralysis after administration of succinylcholine [5]. It's essential to rule out this condition when considering a diagnosis of succinylcholine allergy.
• Anaphylaxis: As mentioned earlier, anaphylactic reactions can range from mild to severe and may be caused by various substances, including medications like succinylcholine [14].
• Angioedema: This is a condition characterized by swelling of the skin and mucous membranes, which can be caused by allergic reactions or other factors.
• Systemic contact dermatitis: This is a type of skin reaction that can occur in response to exposure to certain substances.

It's crucial to consider these conditions when evaluating patients for succinylcholine allergy. A thorough medical history, physical examination, and laboratory tests may be necessary to rule out these differential diagnoses.

According to the search results, the differential diagnosis of any adverse reaction during or following anesthesia should exclude the possibility of other conditions that can simulate anaphylaxis [13]. This emphasizes the importance of a comprehensive evaluation in such cases.

References: [5] Pseudocholinesterase deficiency causes the muscles to stay relaxed for too long after getting succinylcholine. This prevents you from moving or breathing on your own. [13] The differential diagnosis of any adverse reaction during or fol1owing anaesthesia should exclude the possibility of other conditions that can simulate anaphylaxis. [14] Intraoperative anaphylactic reactions may range from mild, erythema-like to anaphylactic shock, with tension crash and bronchospasm.