VI. Dyes, preservatives, antiseptics


Carboxymethylcellulose sodium is a highly viscous material used in pharmaceutical preparations as a suspending agent to promote dissolution of compounds with poor water solubility (barium enema, corticosteroids).
 
Incidence
Infrequent.
 
Described with barium enema (differentiate from other ingredients: methylparaben, latex, carrageenan) and corticosteroids (cortivazol, prednisolone acetate, triamcinolone acetonide).
 
Clinical manifestations
General: anaphylactic shock.
 
Respiratory: bronchospasm.
 
Cutaneous: pruritus, urticaria, angioedema.
 
Diagnostic methods
Cutaneous testing
 
Skin-prick tests: 1%.
 
Intradermal skin-tests: 1/100000 to 1/10000.
 
Scratch-tests: positive with the drug and carboxymethylcellulose.
 
Specific IgE: one case.
 
Specific histamine release: 2 cases.
 
Mechanisms
IgE-mediated hypersensitivity.
 
Management
Avoidance is extremely difficult due to the extensive use of carboxymethylcellulose (drugs and foods).

References

  1. Muroi N, Nishibori M, Fujii T, Yamagata M, Hosoi S, Nakaya N, Saeki K, Henmi K, "Anaphylaxis from the carboxymethylcellulose component of barium sulfate suspension", N. Engl. J. Med., 1997; 337 (18): 1275-7
  2. Patterson D.L, Yunginger J.W, Dunn W.F, Jones R.T, Hunt L.W, "Anaphylaxis induced by the carboxymethylcellulose component of injectable triamcinolone acetonide suspension (Kenalog)", Ann. Allergy. Asthma. Immunol., 1995; 74 (2): 163-6
  3. Beaudouin E, Kanny G, Gueant J.L, Moneret-Vautrin D.A, "Anaphylaxie à la carboxymethylcellulose: à propos de deux cas de chocs à des corticoïdes injectables", Allerg. Immunol. (Paris)., 1992; 24 (9): 333-5

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