Korean J Pain.  2015 Apr;28(2):153-155. 10.3344/kjp.2015.28.2.153.

Delayed Allergic Reaction to Secondary Administrated Epidural Hyaluronidase

• Park AR
• Kim WM
• Heo BH

• KMID: 2278281
• DOI: http://doi.org/10.3344/kjp.2015.28.2.153

Abstract

We are reporting a rare case of a delayed hypersensitivity reaction caused by hyaluronidase allergy following a lumbar transforaminal epidural block. Using an intradermal skin test, we have provided evidence that the systemic allergic reaction resulted from hypersensitivity to hyaluronidase. To our knowledge, this is a rare case of a delayed hypersensitivity reaction to epidural hyaluronidase, comprised of an initial exposure to hyaluronidase with no subsequent allergic response in prior block followed by a subsequent delayed reaction to hyaluronidase during a second epidural block.

Keyword

Allergy; Epidural; Hyaluronidase; Hypersensitivity; Pain; Skin test

MeSH Terms

Hyaluronoglucosaminidase*
Hypersensitivity*
Hypersensitivity, Delayed
Skin Tests
Hyaluronoglucosaminidase

Figure

• 

  Fig. 1 A positive result was found for hyaluronidase (15 IU/ml) with a persistent wheal.

Reference

1. Delaere L, Zeyen T, Foets B, Van Calster J, Stalmans I. Allergic reaction to hyaluronidase after retrobulbar anaesthesia: a case series and review. Int Ophthalmol. 2009; 29:521–528. PMID: 18784901.

2. Szépfalusi Z, Nentwich I, Dobner M, Pillwein K, Urbanek R. IgE-mediated allergic reaction to hyaluronidase in paediatric oncological patients. Eur J Pediatr. 1997; 156:199–203. PMID: 9083759.

3. Geurts JW, Kallewaard JW, Richardson J, Groen GJ. Targeted methylprednisolone acetate/hyaluronidase/clonidine injection after diagnostic epiduroscopy for chronic sciatica: a prospective, 1-year follow-up study. Reg Anesth Pain Med. 2002; 27:343–352. PMID: 12132057.

4. Kempeneers A, Dralands L, Ceuppens J. Hyaluronidase induced orbital pseudotumor as complication of retrobulbar anesthesia. Bull Soc Belge Ophtalmol. 1992; 243:159–166. PMID: 1302146.

5. Kirby B, Butt A, Morrison AM, Beck MH. Type I allergic reaction to hyaluronidase during ophthalmic surgery. Contact Dermatitis. 2001; 44:52. PMID: 11156027.

6. Leibovitch I, Tamblyn D, Casson R, Selva D. Allergic reaction to hyaluronidase: a rare cause of orbital inflammation after cataract surgery. Graefes Arch Clin Exp Ophthalmol. 2006; 244:944–949. PMID: 16362314.

7. Minning CA Jr. Hyaluronidase allergy simulating expulsive choroidal hemorrhage. Arch Ophthalmol. 1994; 112:585–586. PMID: 8185511.

8. Feighery C, McCoy EP, Johnston PB, Armstrong DK. Delayed hypersensitivity to hyaluronidase (Hyalase) used during cataract surgery. Contact Dermatitis. 2007; 57:343. PMID: 17937752.

9. Avellanal M, Diaz-Reganon G. Interlaminar approach for epiduroscopy in patients with failed back surgery syndrome. Br J Anaesth. 2008; 101:244–249. PMID: 18552347.

10. Schulze C, Bittorf T, Walzel H, Kundt G, Bader R, Mittelmeier W. Experimental evaluation of hyaluronidase activity in combination with specific drugs applied in clinical techniques of interventional pain management and local anaesthesia. Pain Physician. 2008; 11:877–883. PMID: 19057633.

11. Girish KS, Kemparaju K. The magic glue hyaluronan and its eraser hyaluronidase: a biological overview. Life Sci. 2007; 80:1921–1943. PMID: 17408700.

12. Kim TW, Lee JH, Yoon KB, Yoon DM. Allergic reactions to hyaluronidase in pain management -A report of three cases-. Korean J Anesthesiol. 2011; 60:57–59. PMID: 21359084.