Allergy Asthma Immunol Res.  2017 Jan;9(1):92-95. 10.4168/aair.2017.9.1.92.

Palonosetron-Induced Anaphylaxis During General Anesthesia: A Case Report

• Park H
• Oh K
• Lee H
• Lee JH
• Kang SM
• Park SY
• Kwon HS
• Cho YS
• Moon HB
• Kim TB

• KMID: 2355899
• DOI: http://doi.org/10.4168/aair.2017.9.1.92

Abstract

Palonosetron is a 5-hydroxytryptamine-3 (5-HT-3) receptor antagonist used for preventing postoperative nausea and vomiting. Compared with ondansetron and granisetron, it is a better drug because of prolonged action and minimal side effects. Some adverse effects of palonosetron have been reported. In this report, we describe a 37-year-old male who developed severe hypersensitivity reactions to palonosetron during surgery for kidney donation. His medical history was unremarkable, except for inguinal hernia with herniorrhaphy 8 years ago. The surgery was uneventful until 2 hours 20 minutes. After palonosetron injection, his blood pressure dropped to 80/50 mm Hg, and facial edema, rash, conjunctival swelling, and wheezing developed. The patient was resuscitated by administration of ephedrine, hydrocortisone, and peniramine. Following the surgery, the patient was monitored for 3 days, and there were no subsequent anaphylactic reactions or other complications. The skin test on postoperative day 54 was positive for hypersensitivity to palonosetron. Although palonosetron is known for its safety, other hypersensitivity events have been reported. Ondansetron is another widely used 5-HT-3 antagonist, which has been reported to cause anaphylaxis. Therefore, clinicians should be aware of the possibility of patients experiencing severe adverse reactions to palonosetron.

Keyword

Anaphylaxis; drug hypersensitivity; serotonin 5-jydroxytryptamine-3 receptor antagonist; palonosetron

MeSH Terms

Adult
Anaphylaxis*
Anesthesia, General*
Blood Pressure
Drug Hypersensitivity
Edema
Ephedrine
Exanthema
Granisetron
Hernia, Inguinal
Herniorrhaphy
Humans
Hydrocortisone
Hypersensitivity
Kidney
Male
Ondansetron
Postoperative Nausea and Vomiting
Respiratory Sounds
Skin Tests
Ephedrine
Granisetron
Hydrocortisone
Ondansetron

Figure

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  Fig. 1 Chemical structure of antiemetics.

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  Fig. 2 Chart summarizing the vital signs of the patient with anaphylaxis. Arrows indicate drug administrations: the first narrow arrow, 450 mg of pentothal sodium, 60 mg of rocuronium, and 50 µg of fentanyl; the second narrow arrow, 50 µg of fentanyl; arrowhead, palonosetron; and wide arrow, 5 mg of ephedrine twice, followed by 10 mg of ephedrine twice. Circle indicates the appearance of rash, facial edema, and conjunctival swelling with immediate administration of 4 mg of chlorpheniramine and 100 mg of hydrocortisone. sBP, systolic blood pressure; dBP, diastolic blood pressure.

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  Fig. 3 Skin test to determine hypersensitivity to palonosetron at dilutions of 1:1, 1:10, 1:100, and 1:1,000. H, control (histamine); N, control (saline). On POD 54, the sizes of wheals were as follows: histamine, 9.5 mm; saline, 2 mm; palonosetron 1:1, 13.86 mm; palonosetron 1:10, 8.5 mm; palonosetron 1:100, 9.5 mm; and palonosetron, 1:1,000, no wheal. POD, postoperative day.

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