Vitamin B1 or thiamine hydrochloride is used in thiamine deficiency syndromes (cardiovascular beriberi syndrome and central Wernicke-Korsakoff syndrome). Thiamine is the most allergenic vitamin.
9 deaths reported between 1965 and 1985, but only 0.1% major reactions and 1% minor local reactions in a large study (1070 consecutive parenteral administrations of thiamine hydrochloride).
Multiple large doses.
Parenteral administration (IV, IM, SC).
Allergic symptoms upon prior administration.
General: anaphylactic shock
Cutaneous: erythema, itching of palms, urticaria.
Digestive: nausea, abdominal cramps.
A few cases of positive skin prick-tests or intradermal tests (0.5 to 5 mg/ ml)
Specific IgE and IgG (ELISA).
Specific histamine release.
Thiamine may act as a hapten (transformation to an azoprotein).
Administration of parenteral thiamine only when required (thiamine defiency).