Katelaris Constance H, Kurosawa Motohiro, Moon Hee-Bom, Borres Magnus, Florvaag Erik, Johansson Stig Gunnar Olof
Campbelltown Hospital, University of Western Sydney, Sydney 2560, Australia.
Gunma Institute for Allergy and Asthma, Tatebayashi-Kosei Hospital, Tatebayashi 374-0055, Japan.
Asia Pac Allergy. 2014 Apr;4(2):86-90. doi: 10.5415/apallergy.2014.4.2.86. Epub 2014 Apr 29.
Accumulating data indicates that pholcodine (PHO)-consuming countries have higher sero-prevalences of immunoglobulin E (IgE)-antibodies to PHO and suxamethonium (SUX) and increased frequencies of IgE-mediated anaphylaxis to neuromuscular blocking agents (NMBAs) than nonconsuming. Withdrawing PHO-containing cough syrups resulted in a significant decrease of cases with anaphylaxis in Scandinavia. Nevertheless, the European Medicines Agency in 2011 advised to continue the unrestricted use throughout the European Union.
To extend studies on PHO consumption and prevalence of IgE-sensitization to morphine (MOR), PHO, and SUX to countries representing high (Australia), and low (Korea and Japan), consumers, respectively.
IgE-antibodies to SUX, MOR, and PHO in atopic subjects were determined by immunoassay and compared with official figures for PHO consumption and reported anaphylaxis to NMBA.
The prevalences of IgE-antibodies to PHO, MOR, and SUX were 10%, 8.6%, and 4.3%, respectively, in Australia. The corresponding figures for Japan were 0.8%, 0.8%, and 1.5%, and for Korea 1.0% to PHO and 0.5% to MOR and SUX. Of the SUX-positive sera, 100% were positive to PHO or MOR in Australia and 0% in Japan and Korea.
The study supports previous findings; exposure to PHO may induce IgE-antibodies to the substituted ammonium ion epitope of NMBAs, thus increasing risk of NMBA-induced anaphylaxis considerably. However, other, still unknown factors occasionally might induce IgE-antibodies to SUX.
越来越多的数据表明，与未使用含福尔可定（PHO）产品的国家相比，使用PHO的国家中，针对PHO和琥珀酰胆碱（SUX）的免疫球蛋白E（IgE）抗体血清流行率更高，且IgE介导的对神经肌肉阻滞剂（NMBA）过敏反应的发生率也更高。在斯堪的纳维亚半岛，停用含PHO的止咳糖浆后，过敏反应病例显著减少。尽管如此，欧洲药品管理局在2011年建议在整个欧盟继续无限制使用。
分别将关于PHO使用情况以及对吗啡（MOR）、PHO和SUX的IgE致敏率的研究扩展至PHO高消费国家（澳大利亚）和低消费国家（韩国和日本）。
通过免疫测定法测定特应性受试者中针对SUX、MOR和PHO的IgE抗体，并与PHO消费官方数据以及报告的对NMBA过敏反应情况进行比较。
在澳大利亚，针对PHO、MOR和SUX的IgE抗体流行率分别为10%、8.6%和4.3%。日本的相应数据分别为0.8%、0.8%和1.5%，韩国针对PHO的为1.0%，针对MOR和SUX的为0.5%。在澳大利亚，SUX阳性血清中100%对PHO或MOR呈阳性，而在日本和韩国为0%。
该研究支持先前的发现；接触PHO可能诱导产生针对NMBA替代铵离子表位的IgE抗体，从而显著增加NMBA诱导过敏反应的风险。然而，其他尚不清楚的因素偶尔也可能诱导产生针对SUX的IgE抗体。
