Meperidine - pethidine


Narcotic analgesic frequently used for analgesia and general anesthesia (induction).
 
Incidence
Very low.
 
Clinical manifestations
General: anaphylactic shock.
 
Cutaneous: flush, urticaria.
 
Respiratory: cough, wheezing.
 
Diagnostic methods
Specific IgE (RAST): positive in a few cases of anaphylaxis.
 
Immediate skin-tests may be positive (do not exceed a concentration of 1/100000).
 
Mechanisms
IgE-mediated hypersensitivity.
 
Non-specific histamine release (meperidine is one of the strongest histamine-releasers of all anaesthetic agents).
 
Management
Avoidance.

References

  1. Flacke J.W, Flacke W.E, Bloom B.C, Van Etton A.P, Kripke B.J, "Histamine release by 4 narcotics: a double blind study in humans", Anesth. Analg., 1987 ; 66: 723-30.
  2. Levy J.H, Rockoff M.A, "Anaphylaxis to meperidine", Anesth. Analg., 1982 ; 61 (3): 301-3
  3. Waisbren B.A, "Hypersensitivity to meperidine", JAMA, 1978 ; 239 (14): 1395

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.