Korean J Pain.  2011 Dec;24(4):221-225. 10.3344/kjp.2011.24.4.221.

Anaphylactic Shock Caused by the Epidurally-Administered Hyalurinidase

• Lee HK
• Choi EJ
• Lee PB
• Nahm FS

• KMID: 2074017
• DOI: http://doi.org/10.3344/kjp.2011.24.4.221

Abstract

Hyaluronidase is an enzyme that has temporary and reversible enzymatic effects on the matrix of connective tissue. When added to local anesthetics in pain treatments, it enhances their infiltration and dispersal into tissues. It is widely used in anesthesia for ocular, dental, and plastic surgery. Reports of drug hypersensitivity to hyaluronidase are rare and are usually confined to peribulbar or retrobulbar anesthesia during ophthalmic surgery. However, few reports exist on adverse drug reaction after epidural injection. We have observed two patients experiencing anaphylactic shock caused by hyaluronidase following epidural injection. Most of the patients with a hypersensitivity to hyaluronidase had one previous uneventful injection containing hyaluronidase, implying that sensitization had taken place. However, hypersensitivity occurring at the first administration is possible. A positive skin test can help establish the diagnosis. Although rare, the possibility of an allergic reaction to hyaluronidase should be considered even in patients with no known previous exposure.

Keyword

adverse drug reaction; drug hypersensitivity; epidural injection; hyaluronidase

MeSH Terms

Anaphylaxis
Anesthesia
Anesthetics, Local
Connective Tissue
Drug Hypersensitivity
Drug Toxicity
Humans
Hyaluronoglucosaminidase
Hypersensitivity
Hypogonadism
Injections, Epidural
Mitochondrial Diseases
Ophthalmoplegia
Skin Tests
Surgery, Plastic
Anesthetics, Local
Hyaluronoglucosaminidase
Hypogonadism
Mitochondrial Diseases
Ophthalmoplegia

Figure

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  Fig. 1 Fluoroscopic image of left L5 transforaminal epidural injection. There is no vascular uptake.

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  Fig. 2 This figure shows the generalized skin rash and urticaria of patient's body.

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  Fig. 3 Fluoroscopic image of caudal epidural block. There is no vascular uptake.

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