Non-IgE-Dependent Hypersensitivity to Rocuronium Reversed by Sugammadex: Report of Three Cases and Hypothesis on the Underlying Mechanism

• Published in: International archives of allergy and immunology Vol. 169; no. 4; p. 256
• Main Authors: Spoerl, David, D'Incau, Stéphanie, Roux-Lombard, Pascale, Harr, Thomas, Czarnetzki, Christoph
• Format: Journal Article
• Language: English
• Published: Switzerland 01-01-2016
• Subjects: Adult; Aged; Androstanols - adverse effects; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - drug therapy; Drug Hypersensitivity - etiology; Female; gamma-Cyclodextrins - therapeutic use; Humans; Male; Middle Aged; Neuromuscular Nondepolarizing Agents - adverse effects; Phenotype; Skin Tests
• ISSN: 1423-0097
• DOI: 10.1159/000446182

We present 3 cases of pseudoallergic (anaphylactoid) reactions to perioperatively administered rocuronium, which rapidly resolved after sugammadex injection. Allergological workup showed no evidence for immediate-type hypersensitivity to the drugs used for anesthesia, including rocuronium. However, rocuronium induced an irritative reaction in skin tests in all 3 patients and in 3 healthy individuals. This reaction was specifically suppressed by adding sugammadex at a 1:1 molecular proportion to rocuronium before the skin tests. This observation suggests that the patients suffered from a pseudoallergic reaction, and indicates that sugammadex might act via the inhibition of non-IgE mediated MRGPRX2 (Mas-related G-protein-coupled receptor member X2)-triggered mast cell degranulation induced by rocuronium.