Lorenz et al classified histamine-release response following drug administration by the severity of the reaction. The authors are from the Universities of Marburg, Heidelberg and Munich in Germany.
NOTE: The grades parallel the grades of anaphylactoid reactions described in Chapter 22.
Clinical Features |
Physician Response |
Grade |
pruritis, erythema, and/or urticaria without systemic symptoms |
not threatening |
I |
hypotension cardiac arrhythmias tachycardia respiratory distress |
serious requiring observation and/or management |
II |
severe hypotension (shock) serious ventricular arrhythmias cardiac arrest serious bronchospasm respiratory arrest |
life-threatening requiring emergency care |
III |
Plasma Histamine Level |
Description |
Grade |
<= 1 ng/mL |
cutaneous only |
I |
> 1 ng/mL |
systemic |
II |
> 12 ng/mL |
life-threatening |
III |
where:
• The assay method and normal reference range for the histamine assay were not listed.
• An alternative to criteria for histamine release would be a change in the post-exposure sample vs the pre-exposure sample.
• Mast cell degranulation can release other vasoactive compounds.
• Duda et al used the term histamine release reaction for the clinical findings not associated with an elevation in plasma histamine.
Specialty: Toxicology, Emergency Medicine, Critical Care, Immunology/Rheumatology
ICD-10: ,