Harle D G, Baldo B A, Fisher M M
Kolling Institute of Medical Research, Royal North Shore Hospital, St. Leonards, N.S.W., Australia.
Mol Immunol. 1990 Oct;27(10):1039-45. doi: 10.1016/0161-5890(90)90127-l.
Subjects who experience life-threatening anaphylactic reactions to neuromuscular blocking drugs frequently have serum IgE antibodies that react with substituted ammonium groups on the drugs. Failure to detect drug-reactive antibodies may be due to the nature of the drug-solid support used for testing sera. With this in mind, solid phases of some selected compounds containing substituted ammonium groups, in particular triethylamine and morphine, were prepared and used to screen sera in an attempt to increase the frequency of detection of IgE antibodies complementary to tertiary and/or quaternary ammonium groups. For subjects who experienced an anaphylactic reaction to succinylcholine or gallamine, use of the supplementary assays increased the frequency of detection from 83 to 100%. For d-tubocurarine and alcuronium, detections increased from 92 to 100% and from 67 to 88%, respectively. Molecular models revealed a clear structural similarity between the conformations of the trialkylammonium groups on one face of the molecules of morphine and d-tubocurarine.
对神经肌肉阻滞药物发生危及生命的过敏反应的患者，其血清IgE抗体常与药物上的取代铵基团发生反应。未能检测到药物反应性抗体可能是由于用于检测血清的药物 - 固相载体的性质所致。考虑到这一点，制备了一些含有取代铵基团的选定化合物的固相，特别是三乙胺和吗啡，并用于筛选血清，试图提高与叔铵和/或季铵基团互补的IgE抗体的检测频率。对于对琥珀酰胆碱或加拉明发生过敏反应的患者，使用补充检测方法使检测频率从83%提高到100%。对于d - 筒箭毒碱和阿库氯铵，检测率分别从92%提高到100%和从67%提高到88%。分子模型显示吗啡和d - 筒箭毒碱分子一侧的三烷基铵基团构象之间存在明显的结构相似性。
