Complement activation-related pseudoallergy caused by liposomes, micellar carriers of intravenous drugs, and radiocontrast agents

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

There is growing awareness that numerous drug-induced immediate hypersensitivity reactions (HSRs) do not fit in Gell and Coombs' Type I category of drug allergies, characterized by the pivotal pathogenic role of allergen-specific IgE. Such non-IgE-mediated "pseudoallergic" reactions are primarily caused by (1) certain liposomal formulations of intravenous drugs and imaging agents, (2) infusion liquids containing micelle-forming amphiphilic lipids or synthetic block-copolymer emulsifiers, and (3) iodinated radiocontrast media with limited solubility in water. Common features of the latter "pseudoallergens" include the capacity to activate the complement (C) system; also, the symptoms they cause are often typical manifestations of excessive anaphylatoxin generation in blood. Hence, these reactions have been called "C activation-related pseudoallergy" (CARPA). The present review surveys the experimental and clinical evidence for the involvement of C activation in HSRs caused by pseudoallergens in the above three categories. To fit CARPA within the classical scheme of HSRs, a subdivision of Type I allergy is proposed on the basis of the mechanism of mast cell (and basophil) activation. The new scheme distinguishes direct and receptor- mediated HSRs, with the latter category subdivided to true IgE-mediated allergy; anaphylatoxin- mediated CARPA; and IgE plus anaphylatoxin double-triggered reactions. Further issues addressed in the review include animal models, risk factors, laboratory predictive tests, and pharmacological prevention of CARPA.

Original languageEnglish
Pages (from-to)567-606
Number of pages40
JournalCritical Reviews in Therapeutic Drug Carrier Systems
Volume18
Issue number6
Publication statusPublished - 2001

Fingerprint

Drug Carriers
Complement Activation
Liposomes
Contrast Media
Anaphylatoxins
Hypersensitivity
Immunoglobulin E
Drug Hypersensitivity
Immediate Hypersensitivity
Drug Compounding
Basophils
Micelles
Mast Cells
Allergens
Solubility
Animal Models
Gels
Pharmacology
Lipids
Water

Keywords

  • Allergy
  • Anaphylactoid reaction
  • Anaphylatoxins
  • Blood substitutes
  • Cancer chemotherapy
  • Complement
  • Cremophor EL
  • Liposomes
  • Micelles
  • Poloxamers
  • Radiocontrast agents
  • Taxol

ASJC Scopus subject areas

  • Pharmacology

Cite this

@article{1ebdf39870f14a43a304408e248313bc,
title = "Complement activation-related pseudoallergy caused by liposomes, micellar carriers of intravenous drugs, and radiocontrast agents",
abstract = "There is growing awareness that numerous drug-induced immediate hypersensitivity reactions (HSRs) do not fit in Gell and Coombs' Type I category of drug allergies, characterized by the pivotal pathogenic role of allergen-specific IgE. Such non-IgE-mediated {"}pseudoallergic{"} reactions are primarily caused by (1) certain liposomal formulations of intravenous drugs and imaging agents, (2) infusion liquids containing micelle-forming amphiphilic lipids or synthetic block-copolymer emulsifiers, and (3) iodinated radiocontrast media with limited solubility in water. Common features of the latter {"}pseudoallergens{"} include the capacity to activate the complement (C) system; also, the symptoms they cause are often typical manifestations of excessive anaphylatoxin generation in blood. Hence, these reactions have been called {"}C activation-related pseudoallergy{"} (CARPA). The present review surveys the experimental and clinical evidence for the involvement of C activation in HSRs caused by pseudoallergens in the above three categories. To fit CARPA within the classical scheme of HSRs, a subdivision of Type I allergy is proposed on the basis of the mechanism of mast cell (and basophil) activation. The new scheme distinguishes direct and receptor- mediated HSRs, with the latter category subdivided to true IgE-mediated allergy; anaphylatoxin- mediated CARPA; and IgE plus anaphylatoxin double-triggered reactions. Further issues addressed in the review include animal models, risk factors, laboratory predictive tests, and pharmacological prevention of CARPA.",
keywords = "Allergy, Anaphylactoid reaction, Anaphylatoxins, Blood substitutes, Cancer chemotherapy, Complement, Cremophor EL, Liposomes, Micelles, Poloxamers, Radiocontrast agents, Taxol",
author = "J. Szebeni",
year = "2001",
language = "English",
volume = "18",
pages = "567--606",
journal = "Critical Reviews in Therapeutic Drug Carrier Systems",
issn = "0743-4863",
publisher = "Begell House Inc.",
number = "6",

}

TY - JOUR

T1 - Complement activation-related pseudoallergy caused by liposomes, micellar carriers of intravenous drugs, and radiocontrast agents

AU - Szebeni, J.

PY - 2001

Y1 - 2001

N2 - There is growing awareness that numerous drug-induced immediate hypersensitivity reactions (HSRs) do not fit in Gell and Coombs' Type I category of drug allergies, characterized by the pivotal pathogenic role of allergen-specific IgE. Such non-IgE-mediated "pseudoallergic" reactions are primarily caused by (1) certain liposomal formulations of intravenous drugs and imaging agents, (2) infusion liquids containing micelle-forming amphiphilic lipids or synthetic block-copolymer emulsifiers, and (3) iodinated radiocontrast media with limited solubility in water. Common features of the latter "pseudoallergens" include the capacity to activate the complement (C) system; also, the symptoms they cause are often typical manifestations of excessive anaphylatoxin generation in blood. Hence, these reactions have been called "C activation-related pseudoallergy" (CARPA). The present review surveys the experimental and clinical evidence for the involvement of C activation in HSRs caused by pseudoallergens in the above three categories. To fit CARPA within the classical scheme of HSRs, a subdivision of Type I allergy is proposed on the basis of the mechanism of mast cell (and basophil) activation. The new scheme distinguishes direct and receptor- mediated HSRs, with the latter category subdivided to true IgE-mediated allergy; anaphylatoxin- mediated CARPA; and IgE plus anaphylatoxin double-triggered reactions. Further issues addressed in the review include animal models, risk factors, laboratory predictive tests, and pharmacological prevention of CARPA.

AB - There is growing awareness that numerous drug-induced immediate hypersensitivity reactions (HSRs) do not fit in Gell and Coombs' Type I category of drug allergies, characterized by the pivotal pathogenic role of allergen-specific IgE. Such non-IgE-mediated "pseudoallergic" reactions are primarily caused by (1) certain liposomal formulations of intravenous drugs and imaging agents, (2) infusion liquids containing micelle-forming amphiphilic lipids or synthetic block-copolymer emulsifiers, and (3) iodinated radiocontrast media with limited solubility in water. Common features of the latter "pseudoallergens" include the capacity to activate the complement (C) system; also, the symptoms they cause are often typical manifestations of excessive anaphylatoxin generation in blood. Hence, these reactions have been called "C activation-related pseudoallergy" (CARPA). The present review surveys the experimental and clinical evidence for the involvement of C activation in HSRs caused by pseudoallergens in the above three categories. To fit CARPA within the classical scheme of HSRs, a subdivision of Type I allergy is proposed on the basis of the mechanism of mast cell (and basophil) activation. The new scheme distinguishes direct and receptor- mediated HSRs, with the latter category subdivided to true IgE-mediated allergy; anaphylatoxin- mediated CARPA; and IgE plus anaphylatoxin double-triggered reactions. Further issues addressed in the review include animal models, risk factors, laboratory predictive tests, and pharmacological prevention of CARPA.

KW - Allergy

KW - Anaphylactoid reaction

KW - Anaphylatoxins

KW - Blood substitutes

KW - Cancer chemotherapy

KW - Complement

KW - Cremophor EL

KW - Liposomes

KW - Micelles

KW - Poloxamers

KW - Radiocontrast agents

KW - Taxol

UR - http://www.scopus.com/inward/record.url?scp=0035660629&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035660629&partnerID=8YFLogxK

M3 - Article

C2 - 11789676

AN - SCOPUS:0035660629

VL - 18

SP - 567

EP - 606

JO - Critical Reviews in Therapeutic Drug Carrier Systems

JF - Critical Reviews in Therapeutic Drug Carrier Systems

SN - 0743-4863

IS - 6

ER -