Anaphylaxis following Administration of Papaveretum. Case Report

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Abstract
IgE antibodies that reacted with morphine and codeine were detected in theserum of a subject who experienced a life-threatening anaphylactic reaction following the administration of Omnopon-Scopolamine (papaveretum-hyoscine). Hapten inhibition studies with morphine and a number of structurally-related analogues revealed that morphine and codeine were the most potent inhibitors of IgE binding to a morphine-solid phase. Nalorphine, meperidine, and methadone were also good inhibitors if IgE binding, but natrexone, buprenorphine, and fetanyl proved to be poor inhibitors. From a detailed examination of a structure-activity relationships, the authors conclude that the important structural features of the morphine allergenic (that is, IgE binding) determinant comprises the cyclohexenyl ring with a hydroxyl group at C-6 and, most important of all, a methyl substituent attached to the N atom. The authors'' findings suggest that morphine analogues administered to such a patient may provoke clinical anaphylaxis. Hyoscine reacted weakly with igE antibodies in the subject''s serum, but this was thought to be due to weak cross-reaction between this compound and morphine.

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