Leading benzodiazepine, widely used against seizures and as a muscle relaxant.
Low in France but one injection out of 1000 when cremophor E.L. was used as the solvent (not in France).
The most common offending molecules are diazepam and flunitrazepam.
General: anaphylactic shock, collapse.
Cutaneous: urticaria, angioedema, hives, flush, polymorphous erythema, purpura.
Respiratory: dyspnea, bronchospasm.
Renal: allergic interstitial nephropathy.
In one case prick-test positive with solvent
In one case patch-test positive
Positive reintroduction test (with caution) if necessary
Major role of solvents (chromophor E.L., propylene glycol, sodium benzoate).
Immediate IgE-mediated hypersensitivity: Prausnitz-Kustner test positive in one case. The active metabolite common to all benzodiazepines is desmethyldiazepam, which appears to be an antigenic molecule and accounts for cross reactivity among different benzodiazepines.
Non-specific histamine release.
Manifestations are usually observed when cremophor E.L. is used as a solvent (not used in France).