Anaphylactic reaction after atropine

Allergic Reaction to Intravenous Atropine in a Patient with Organophosphate Poisoning

Atropine is a drug of choice for muscarinic effects in organophosphate (OP) poisoning. Allergic reaction to atropine is rare. Here, we report a case of a 17-year-old male who was admitted with clinical manifestations of acute OP poisoning. After intravenous atropine injection, cutaneous signs of hypersensitivity including erythema and urticarial were observed on his body. Atropine injection was stopped, and antihistamines and hydrocortisone were administered. His condition was improved, and he discharged with a good condition after 2 days hospitalization. Adverse allergic reaction to atropine should be in mind when managing OP poisoning cases.

Anaphylaxis following atropine administration during general anesthesia: a case report

Anaphylaxis is an acute, potentially lethal, multisystem syndrome resulting from the sudden release of mast-cell- and basophile-derived mediators into the circulation. Common manifestations of anaphylactic reactions include urticaria, angioedema, nausea, vomiting, hypotension and cardiovascular collapse. Cardiovascular collapse is the first detected manifestation in up to 50% of cases in perioperative anaphylaxis, because patients are anesthetized and unable to report symptoms. A 25-year-old male presented with severe hypotension and erythema after intravenous atropine administration during general anesthesia. Postoperative laboratory findings demonstrated elevated serum tryptase and total immunoglobulin E. An intradermal test showed atropine sensitivity. Although atropine is used widely as a perioperative anticholinergic agent, it is a potential risk factor for a severe anaphylactic reaction. Therefore, prompt recognition and adequate therapeutic measures are necessary to avoid fatal consequences.

Acute methaemoglobinaemia initially treated as organophosphate poisoning leading to atropine toxicity

A case of unknown compound poisoning is presented. It was initially treated as organophosphate poisoning with lack of response. A timely diagnosis of acute methaemoglobinaemia and iatrogenic atropine toxicity was made based on clinical evaluation. Treatment of methaemoglobinaemia using oral methylene blue and of atropine toxicity with supportive measures could save the patient.

Cutaneous responses to anticholinergics: evidence for muscarinic receptor subtype participation

We conducted a series of experiments to determine if anticholinergics induce immediate cutaneous wheal-and-flare responses in normal volunteers. We performed intradermal skin testing in seven healthy volunteers (three atopic and four nonatopic) with 20 nmol of atropine. All subjects had an immediate wheal-and-flare response to atropine. To determine if this cutaneous response was due to anticholinergics in general, skin testing was also performed to scopolamine and ipratropium. These agents also produced immediate wheal-and-flare responses in all subjects, but they less potent than atropine. Pretreatment with antihistamines equivalently inhibited wheal-and-flare responses to both histamine and atropine, indicating a possible mast cell role. The potential role of M1, M2, and M3 muscarinic receptor subtypes was evaluated by use of the selective antagonists, pirenzepine (M1), 11[[2-1[(diethylamino)methyl]-1-piperidinyl]-acetyl]-5, 11-dihydro-6H-pyrido[2,3-b][1,4]benzodiazepine-6-one (AFDX-116) (M2), and 4-diphenylacetoxy-N-methylpiperidine (4-DAMP) (M3). Cutaneous wheal responses induced by pirenzepine and 4-DAMP were relatively equivalent and larger than responses induced by AFDX-116 at doses less than 200 nmol. At 200 nmol, all three muscarinic receptor subtype antagonists induced equivalent wheal formation. We then compared the cutaneous wheal responses to these specific muscarinic receptor antagonists based on their relative affinity for their respective muscarinic receptor subtype. This comparison suggested that M1 or M2, but not M3, muscarinic receptor subtypes may be important in anticholinergic-induced cutaneous wheal-and-flare responses. We propose that there may be an M1 or M2 muscarinic autoreceptor that inhibits the release of acetylcholine and other neurotransmitters.(ABSTRACT TRUNCATED AT 250 WORDS)