Harle D G, Baldo B A, Coroneos N J, Fisher M M
Kolling Institute of Medical Research, Royal North Shore Hospital, St. Leonards, N.S.W., Australia.
Anesthesiology. 1989 Oct;71(4):489-94.
IgE antibodies that reacted with morphine and codeine were detected in the serum of a subject who experienced a life-threatening anaphylactic reaction following the administration of Omnopon-Scopolamine (papaveretum-hyoscine). Hapten inhibition studies with morphine and a number of structurally-related analogues revealed that morphine and codeine were the most potent inhibitors of IgE binding to a morphine-solid phase. Nalorphine, meperidine, and methadone were also good inhibitors of IgE binding, but naltrexone, buprenorphine, and fentanyl proved to be poor inhibitors. From a detailed examination of structure-activity relationships, the authors conclude that the important structural features of the morphine allergenic (that is, IgE binding) determinant comprises the cyclohexenyl ring with a hydroxyl group at C-6 and, most important of all, a methyl substituent attached to the N atom. The authors' findings suggest that morphine analogues administered to such a patient may provoke clinical anaphylaxis. Hyoscine reacted weakly with IgE antibodies in the subject's serum, but this was thought to be due to weak cross-reaction between this compound and morphine.
在一名患者血清中检测到与吗啡和可待因发生反应的IgE抗体，该患者在服用Omnopon - 东莨菪碱（罂粟碱 - 东莨菪碱）后发生危及生命的过敏反应。用吗啡和一些结构相关类似物进行的半抗原抑制研究表明，吗啡和可待因是IgE与吗啡固相结合的最有效抑制剂。纳洛啡、哌替啶和美沙酮也是IgE结合的良好抑制剂，但纳曲酮、丁丙诺啡和芬太尼被证明是较差的抑制剂。通过对构效关系的详细研究，作者得出结论，吗啡过敏原（即IgE结合）决定簇的重要结构特征包括在C - 6位带有羟基的环己烯基环，最重要的是，一个连接到N原子上的甲基取代基。作者的研究结果表明，给此类患者使用吗啡类似物可能会引发临床过敏反应。东莨菪碱与该患者血清中的IgE抗体反应较弱，但这被认为是由于该化合物与吗啡之间的弱交叉反应所致。
