High pholcodine consumption in Australia is associated with higher prevalence of IgE antibodies to suxamethonium and probably a higher risk of anaphylaxis to NMBDs.

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• Constance H Katelaris, Motohiro Kurosawa, Hee-Bom Moon, Magnus Borres, Erik Florvaag, and Stig Gunnar Olof Johansson.
• Campbelltown Hospital, University of Western Sydney, Sydney 2560, Australia.
• Asia Pac Allergy. 2014 Apr 1; 4 (2): 86-90.

BackgroundAccumulating 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.ObjectiveTo 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.MethodsIgE-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.ResultsThe 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.ConclusionThe 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.

This article appears in the collections: What is the significance of Pholcodine for anesthesia? and Anaphylaxis to Rocuronium in Australia & New Zealand.

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