5 hydroxytryptamine 3 receptor antagonists


Granisetron, ondansetron and tropisetron are used for prevention of nausea and vomiting associated with cancer chemotherapy.
 
Incidence
Uncommon.
 
Ondansetron: 24 cases (FDA 1994).
 
Tropisetron: 11 cases.
 
Risk factors
Previous reaction with another 5 HT 3 receptor antagonist.
 
Clinical manifestations
Differentiate from non-allergic side-effects (headache, gastrointestinal symptoms).
 
Anaphylactic reactions.
 
Rashes, Facial edema.
 
Bronchospasm.
 
Chest pain.
 
Arrhythmias.
 
Diagnostic methods
Drug re-challenge: positive.
 
Mechanisms
Unknown.
 
Management
Avoidance of all 5 HT 3 receptor antagonists due to effects of drug class.

References

  1. Frigerio C, Buchwalder P.A, Spertini F, "Ondansetron: reasons to be restrictive", Lancet., 1996; 347: 1484-5
  2. Kataja V, de Bruijn K.M, "Hypersensitivity reactions associated with 5 hydroxytryptamine 3 receptor antagonists: a class effect ?", Lancet, 1996; 347: 584-5
  3. Kossey J.L, Kwok K.K, "Anaphylactoid reactions associated with ondansetron", Ann. Pharmacother., 1994; 28 (9): 1029-30

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