Bigliardi P L, Izakovic J, Weber J M, Bircher A J
Department of Dermatology, Kantonsspital Schaffhausen, Schaffhausen, Switzerland.
Dermatology. 2003;207(1):100-3. doi: 10.1159/000070958.
Carboxymethylcellulose is a carbohydrate widely used as additive in tablets, cosmetics, some injectable hormone formulations, food (as E466) and as active principle in hydrocolloid dressings. Anaphylaxis to carboxymethylcellulose in parenteral corticosteroid preparations has previously been reported. Typically, skin tests were positive in such cases, occasionally specific IgE or histamine release have been demonstrated.
We report on 3 patients who suffered from anaphylactic symptoms after local injection of corticosteroid preparations. Intracutaneous skin tests with carboxymethylcellulose were positive; in 2, sulfidoleukotriene release could be measured in the cellular antigen stimulation test (CAST). Specific IgE could not be identified. Oral provocation tests with typical doses of carboxymethylcellulose as found in food and tablets were negative.
In patients with anaphylaxis to parenteral administration of carboxymethylcellulose, small amounts are tolerated by the oral route. Skin tests and CAST are useful diagnostic tools.
羧甲基纤维素是一种碳水化合物，广泛用作片剂、化妆品、某些注射用激素制剂、食品（作为E466）中的添加剂以及水胶体敷料中的活性成分。先前已有关于肠胃外皮质类固醇制剂中羧甲基纤维素过敏反应的报道。通常，此类病例的皮肤试验呈阳性，偶尔也有特异性IgE或组胺释放的证明。
我们报告了3例在局部注射皮质类固醇制剂后出现过敏症状的患者。用羧甲基纤维素进行的皮内皮肤试验呈阳性；其中2例在细胞抗原刺激试验（CAST）中可检测到硫代白三烯释放。未发现特异性IgE。用食品和片剂中常见剂量的羧甲基纤维素进行的口服激发试验为阴性。
对于肠胃外给予羧甲基纤维素过敏的患者，口服少量该物质可耐受。皮肤试验和CAST是有用的诊断工具。
