Allergy Asthma Respir Dis.  2014 May;2(2):146-149. 10.4168/aard.2014.2.2.146.

Vitamin K-induced anaphylaxis

Affiliations
  • 1Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea. jomlee@knu.ac.kr

Abstract

Vitamin K is a naturally-occurring vitamin used to treat certain coagulation disorders. Despite its frequent use, vitamin K causes allergic reactions very rarely. We report a case of anaphylaxis due to vitamin K (phytonadione) that occurred in a 20-year-old man who has undergone hemorrhoid bleeding. The patient developed immediate whole body urticaria, itching sensation, dyspnea and marked hypotension about 2 minutes after the intravenous administration of vitamin K (phytonadione) and tranexamic acid for the purpose of bleeding control. Skin prick test was performed with vitamin K and tranexamic acid. Vitamin K showed positive response in skin prick test, while tranexamic acid showed negative response in skin prick test and challenge test. To our knowledge, it is the first case report of vitamin K-induced anaphylaxis that is proven with skin test. This case suggests that vitamin K can elicit anaphylaxis and skin test may be helpful in the diagnosis of a suspected allergic response to vitamin K.

Keyword

Anaphylaxis; Drug hypersensitivity; Vitamin K; Skin tests

MeSH Terms

Administration, Intravenous
Anaphylaxis*
Diagnosis
Drug Hypersensitivity
Dyspnea
Hemorrhage
Hemorrhoids
Humans
Hypersensitivity
Hypotension
Pruritus
Sensation
Skin
Skin Tests
Tranexamic Acid
Urticaria
Vitamin K
Vitamins*
Young Adult
Tranexamic Acid
Vitamin K
Vitamins

Figure

  • Fig. 1 Skin prick test with vitamin K. Positive reactions were observed at skin prick of vitamin K 1:10 ("1:10"), vitamin K undiluted solution ("undiluted solution"). S, saline as a negative control; H, histamine as a positive control.

  • Fig. 2 Skin prick test with tranexamic acid. No reaction was seen in tranexamic acid 1:100 ("T 1:100"), tranexamic acid 1:10 ("1:10") and tranexamic acid undiluted solution ("undiluted solution").


Reference

1. Li J, Lin JC, Wang H, Peterson JW, Furie BC, Furie B, et al. Novel role of vitamin k in preventing oxidative injury to developing oligodendrocytes and neurons. J Neurosci. 2003; 23:5816–5826.
Article
2. Fang Y, Hu C, Tao X, Wan Y, Tao F. Effect of vitamin K on bone mineral density: a meta-analysis of randomized controlled trials. J Bone Miner Metab. 2012; 30:60–68.
Article
3. Marcus R, Coulston A. Fat-soluble vitamins. In : Gilman AG, Hardman JG, Limbird LE, Molinoff PB, Ruddon RW, editors. Goodman and Gilman's the pharmacological basis of therapeutics. 9th ed. New York: McGraw-Hill;1996. p. 1573–1590.
4. Barash P, Kitahata LM, Mandel S. Acute cardiovascular collapse after intravenous phytonadione. Anesth Analg. 1976; 55:304–306.
5. Songy KA Jr, Layon AJ. Vitamin K-induced cardiovascular collapse. J Clin Anesth. 1997; 9:514–519.
Article
6. Kim K, Chae YS, Suh KS, Kim ST. Clinical features and provocation tests of vitamin K1 dermatitis. Korean J Dermatol. 1993; 31:305–311.
7. Seo SH, Jang HS, Jang BS, Kim MB, Oh CK, Kwon KS. A case of vitamin K1 dermatitis. Korean J Dermatol. 2006; 44:341–345.
8. Sohn KH, Kim JY, Lee SY, Lee SE, Kang HR. A case of vitamin K1 induced allergic dermititis. Korean J Asthma Allergy Clin Immunol. 2012; 32:268–271.
9. Wjasow C, McNamara R. Anaphylaxis after low dose intravenous vitamin K. J Emerg Med. 2003; 24:169–172.
Article
10. Riegert-Johnson DL, Volcheck GW. The incidence of anaphylaxis following intravenous phytonadione (vitamin K1): a 5-year retrospective review. Ann Allergy Asthma Immunol. 2002; 89:400–406.
Article
11. Ribeiro-Vaz I, Marques J, Demoly P, Polonia J, Gomes ER. Drug-induced anaphylaxis: a decade review of reporting to the Portuguese Pharmacovigilance Authority. Eur J Clin Pharmacol. 2013; 69:673–681.
Article
12. Park SJ, Seong CR, Jee DL. Intravenous Vitamin K-induced cardiovascular collapse: a case report. Korean J Anesthesiol. 2007; 52:461–464.
Article
13. Brown SG, Mullins RJ, Gold MS. Anaphylaxis: diagnosis and management. Med J Aust. 2006; 185:283–289.
14. Yeo JY, Kim GE, Han JY, Im JH, Park SW, Kim CW. Lidocaine anaphylaxis and lidocaine-specific immunoglobulin E measurement. Allergy Asthma Respir Dis. 2013; 1:98–101.
Article
15. Mertes PM, Laxenaire MC, Alla F. Groupe d'Etudes des Réactions Anaphylactoïdes Peranesthésiques. Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999-2000. Anesthesiology. 2003; 99:536–545.
Article
16. Simons FE, Schatz M. Anaphylaxis during pregnancy. J Allergy Clin Immunol. 2012; 130:597–606.
Article
17. Dybendal T, Guttormsen AB, Elsayed S, Askeland B, Harboe T, Florvaag E. Screening for mast cell tryptase and serum IgE antibodies in 18 patients with anaphylactic shock during general anaesthesia. Acta Anaesthesiol Scand. 2003; 47:1211–1218.
Article
18. Lefrère JJ, Girot R. Acute cardiovascular collapse during intravenous vitamin K1 injection. Thromb Haemost. 1987; 58:790.
Article
19. Korosec P, Erzen R, Silar M, Bajrovic N, Kopac P, Kosnik M. Basophil responsiveness in patients with insect sting allergies and negative venom-specific immunoglobulin E and skin prick test results. Clin Exp Allergy. 2009; 39:1730–1737.
Article
Full Text Links
  • AARD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr