Abstract
We investigated histamine release in five female patients, submitted for gynaecological surgery, after intravenous administration of the neuromuscular blocking agent d-tubocurarine. In these patients we measured the plasma levels of histamine and its metabolites, Nτ-methylhistamine and Nτ-methylimidazoleacetic acid, making use of mass fragmentographic methods. The newly developed determination of plasma Nτ-methylimidazoleacetic acid had a within-day coefficient of variation of 2.7% (n=10). Normal values of Nτ-methylimidazoleacetic acid in plasma ranged from 41.3–75.6 nmol/l (n=13). All five patients developed anaphylactoid reactions: two patients showed severe systemic reactions, one patient a minor systemic reaction and two had skin reactions only. Plasma histamine and Nτ-methylhistamine levels appeared to be the most reliable biochemical parameters for confirming both the occurrence and severity of an anaphylactoid reaction. In comparison with plasma histamine, the determination of plasma Nτ-methylhistamine is less hampered by artefacts caused by blood collection and plasma preparation. Together with the fact that the increase in plasma Nτ-methylhistamine levels after anaphylactoid reactions lasts much longer than the increase in plasma histamine levels, this leads to the conclusion that the determination of plasma Nτ-methylhistamine is a useful retrospective parameter for histamine release in this type of pathological state. The plasma Nτ-methylimidazoleacetic acid levels fluctuated considerably, showing only a significant increase after administration of d-tubocurarine in the two patients who had severe anaphylactoid reactions. This parameter is, therefore, less useful in such studies.
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Oosting, E., Richardson, F.J., Keyzer, J.J. et al. Histamine metabolism after adverse reactions due to d-tubocurarine administration. Agents and Actions 21, 54–61 (1987). https://doi.org/10.1007/BF01974921
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DOI: https://doi.org/10.1007/BF01974921