Morphine


Morphine, historically chief among the opioids , is widely used as an analgesic in various clinical situations (postoperative period, cancer).
 
Incidence
Extremely rare.
 
Clinical manifestations
General: anaphylactic shock.
 
Cutaneous: urticaria.
 
Respiratory: bronchospasm.
 
Diagnostic methods
Cutaneous testing
 
Intradermal skin-tests: positive 1/100 000 (solution of 10 mg/ ml)
 
Specific IgE (RIA morphine-sepharose) positive in a patient.
 
Mechanisms
Nonspecific histamine release.
 
IgE-mediated hypersensitivity: the morphine allergenic determinant comprises the cyclohexenyl ring, with a hydroxyl group at C6 and a methyl substituent attached to the N-atom.
 
Management
Avoidance.
 
Cross-reactivity with codeine and other opioids may occur.
 

References

  1. Harle D.G, Baldo B.A, Coroneos N.J, Fisher M.M, "Anaphylaxis following administration of papaveretum. Case report: implication of IgE antibodies that react with morphine and codeine and identification of an allergic determinant". Anesthesiology., 1989 ; 71 (4): 489-94
  2. Rossi R, Dick W, "Anaphylactoide reaktion nach intravenöser injektion von morphinum hydrochloricum", Anesthesist. , 1982 ; 31: 463-5
  3. Fahmy N.R, "Hemodynamics, plasma histamine and catecholamine concentrations during an anaphylactoid reaction to morphine", Anesthesiology, 1981 ; 55: 329-31

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