Thiamine (Vitamin B1)


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.
 
Incidence
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).
 
Risk factors
Multiple large doses.
 
Parenteral administration (IV, IM, SC).
 
Allergic symptoms upon prior administration.
 
Clinical manifestations
General: anaphylactic shock
 
Respiratory: bronchospasm.
 
Cutaneous: erythema, itching of palms, urticaria.
 
Digestive: nausea, abdominal cramps.
 
Diagnostic methods
Cutaneous testing.
 
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.
 
Mechanisms
Thiamine may act as a hapten (transformation to an azoprotein).
 
Management
Administration of parenteral thiamine only when required (thiamine defiency).

References

  1. Fernandez M, Barcelo M, Munoz C, Torrecillas M, Blanca M, "Anaphylaxis to thiamine (vitamin B1)", Allergy., 1997; 52: 958-60
  2. Proebstle T.M, Gall H, Jugert F.K, Merk H.F, Sterry W, "Specific IgE and IgG serum antibodies to thiamine associated with anaphylactic reaction", J. Allergy. Clin. Immunol., 1995; 95: 1059-60
  3. Stephen J.M, Grant R, Yeh C.S, "Anaphylaxis from administration of intravenous thiamine", Am. J. Emerg. Med., 1992; 10 (1): 61-3
  4. Wrenn K.D, Murphy F, Slovis C.M, "A toxicity study of parenteral thiamine hydrochloride", Ann. Emerg. Med., 1989; 18: 867-70

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