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

Research output: Contribution to journalReview article

98 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
DOIs
Publication statusPublished - Jan 1 2001

Keywords

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

ASJC Scopus subject areas

  • Pharmacology
  • Pharmaceutical Science

Fingerprint Dive into the research topics of 'Complement activation-related pseudoallergy caused by liposomes, micellar carriers of intravenous drugs, and radiocontrast agents'. Together they form a unique fingerprint.

  • Cite this