Mannitol


Mannitol is a hexahydric alcohol closely related to the hexose sugars ; which has been used in a variety of clinical situations for its osmotic diuretic qualities (chemotherapy, cerebral edema).
 
Incidence
Very low. Fewer than 10 cases reported.
 
Risk factors
Atopy.
 
Clinical manifestations
General: anaphylactic shock.
 
Cutaneous: urticaria, rash, pruritus, periorbital edema.
 
Respiratory: sneezing, bronchospasm, chest tightness.
 
Diagnostic methods
Cutaneous testing.
 
Intradermal skin-tests positive at 1/100.
 
No specific IgE.
 
Specific histamine-release (RIA method) positive in a patient with anaphylactic shock.
 
Mechanisms
Hyperosmolar solutes are capable of inducing non-cytotoxic basophil histamine release.
 
IgE-mediated hypersensitivity: positive cutaneous tests, specific histamine-release.
 
Management
Avoidance.
 

References

  1. Schmid P, Wuthrich B, "Peranaesthetic anaphylactoid shock due to mannitol", Allergy, 1992 ; 47 (1): 61-2
  2. Ackland S.P, Hillcoat B.L, "Immediate hypersensitivity to mannitol: a potential cause of apparent hypersensitivity to cisplatin", Cancer. Treat. Rep., 1985 ; 69 (5): 562-3
  3. Mc Neill I.Y, "Hypersensitivity reaction to mannitol", Drug. Intell. Clin. Pharm., 1985 ; 19 (7-8): 552-3
  4. Findlay S.R, Kagey-Sobotka A, Lichtenstein L.M, "In vitro basophil histamine-release induced by mannitol in a patient with mannitol-induced anaphylactoid reaction", J. Allergy. Clin. Immunol., 1984 ; 73 (5.1): 578-83
  5. Lamb J.D, Keogh J.A, "Anaphylactoid reaction to mannitol", Can. Anaesth. Soc. J., 1979 ; 26 (5): 435-6

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