A Case of Sugammadex, Induced Anaphylaxis Determined by Basophil Activation Test and Prick Test

Abstract

Three years earlier, a 37-year-old woman underwent resection for right Knuck’s canal edema under general anesthesia. Resection was successful, but after extubation, erythema and hypotension appeared. Rocuronium, a muscle relaxant that was administered intraoperatively, and sugammadex, a muscle relaxant antagonist, were suspected to be causative agents of the anaphylaxis ; however, lymphocyte stimulation test was negative for both drugs. As the patient was scheduled for another surgery under general anesthesia, she came to our department for further investigation. Basophil activation test (BAT) and prick test showed positive ndings only for sugammadex ; hence, we diagnosed postoperative hypotension and generalized erythema caused by an immediate anaphylactic shock to sugammadex. As the patient did not show symptoms following initial administration of sugammadex, a possible mechanism for the delayed anaphylactic symptoms was due to sensitization because the basic component of the drug, γ-cyclodextrin, is contained in many dietary supplements and cosmetics. Skin Research, 22 : 1-6, 2023