Armentia A, Ruiz-Muñoz P, Quesada J M, Postigo I, Herrero M, Martín-Gil F J, Gonzalez-Sagrado M, Martín B, Castrodeza J
Allergy Unit, Rio Hortega University Hospital, UMDAI, Valladolid, Spain.
San Juan de Dios Centre, Palencia and Castile-Leon Association For the Aid of Drug Abusers (ACLAD), Valladolid, Spain.
Allergol Immunopathol (Madr). 2013 Jan-Feb;41(1):37-44. doi: 10.1016/j.aller.2011.05.011. Epub 2011 Sep 21.
The diagnosis of anaphylactic reactions due to opiates during anaesthesia can be difficult, since in most cases various drugs may have been administered. Detection of specific IgE to poppy seed might be a marker for sensitisation to opiates in allergic people and heroin-abusers. This study assessed the clinical value of morphine, pholcodine and poppy seed skin-prick and IgE determination in people suffering hypersensitivity reactions during anaesthesia or analgesia and drug-abusers with allergic symptoms.
We selected heroin abusers and patients who suffered severe reactions during anaesthesia and analgesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity and predictive value) of prick and IgE tests in determining opiate allergy was analysed.
Overall, 149 patients and 200 controls, mean age 32.9 ± 14.7 years, were included. All patients with positive prick to opiates showed positive prick and IgE to poppy seeds, but not to morphine or pholcodine IgE. Among drug-abusers, 13/42 patients (31%) presented opium hypersensitivity confirmed by challenge tests. Among non-drug abusers, sensitisation to opiates was higher in people allergic to tobacco (25%), P<.001. Prick tests and IgE against poppy seed had a good sensitivity (95.6% and 82.6%, respectively) and specificity (98.5% and 100%, respectively) in the diagnosis of opiate allergy.
Opiates may be significant allergens. Drug-abusers and people sensitised to tobacco are at risk. Both the prick and specific IgE tests efficiently detected sensitisation to opiates. The highest levels were related to more-severe clinical profiles.
麻醉期间因阿片类药物引起的过敏反应诊断可能存在困难，因为大多数情况下可能已使用多种药物。检测对罂粟籽的特异性IgE可能是过敏人群和海洛因滥用者对阿片类药物致敏的一个标志物。本研究评估了吗啡、福尔可定和罂粟籽皮肤点刺试验及IgE测定在麻醉或镇痛期间发生过敏反应的患者以及有过敏症状的药物滥用者中的临床价值。
我们从23873例患者的数据库中选取了海洛因滥用者以及在麻醉和镇痛期间发生严重反应 的患者。分析了点刺试验和IgE检测在确定阿片类药物过敏方面的诊断率（敏感性、特异性和预测值）。
总共纳入了149例患者和200例对照，平均年龄32.9±14.7岁。所有阿片类药物点刺试验阳性的患者对罂粟籽的点刺试验和IgE检测均呈阳性，但对吗啡或福尔可定IgE检测呈阴性。在药物滥用者中，13/42例患者（31%）经激发试验证实存在鸦片过敏。在非药物滥用者中，对烟草过敏的人群对阿片类药物的致敏率更高（25%），P<0.001。罂粟籽点刺试验和IgE检测在阿片类药物过敏诊断中具有良好的敏感性（分别为95.6%和82.6%）和特异性（分别为98.5%和100%）。
阿片类药物可能是重要过敏原。药物滥用者和对烟草致敏的人群有风险。点刺试验和特异性IgE检测均能有效检测出对阿片类药物的致敏情况。最高水平与更严重的临床特征相关。
