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.
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