Mechanisms in IgE-dependent anaphylaxis to anesthetic drugs.

The discovery of IgE antibodies to neuromuscular blocking drugs, to thiopentone and narcotics, particularly morphine, reinforced earlier beliefs formed from skin test and other clinical findings that many "anaphylactoid" reactions to drugs were true type 1 immediate hypersensitivity reactions. Immunochemical studies established the fine structural specificities of the drug-reactive IgE antibodies and provided an explanation in molecular terms for a number of observed clinical cross-reactions. Subtleties in interpreting relationships between skin tests and IgE radioimmunoassays are pointed out and mechanisms of drug-induced mediator release, persistence of IgE antibodies and the nature of the sensitizing sources are discussed.