To cough or not to cough with pholcodeine. What has this to do with hairdressers?

The story of allergy and anaphylaxis to neuromuscular blocking agents during anaesthesia at the first anaesthetic due to cross-reacting sensitisation from other sources is taken a stage further in this study. Previous work has shown cross-reacting antibodies from quaternary ammonium compounds in sensitised hairdressers. Quaternary ammonium ion epitopes are present in pholcodeine, an over-the-counter cough suppressant available in some countries. The present study is from Norway where there is a compulsory register of anaphylactic reactions during anaesthesia and withdrawal of pholcodeine nationally in 2007. In the following 6 years the relative risk of suxamethonium anaphylaxis was 0.76 after 3 years and 0.65 after 6 years, providing further evidence that pholcodeine was implicated in the original sensitisation (the total sales of suxamethonium at 6 years was 83% of the 2007 sales).

References

	de Pater GH, Florvaag E, Johansson SGO, Irgens Å, Petersen MNH, Guttormsen AB, Six years without pholcodine; Norwegians are significantly less IgE-sensitized and clinically more tolerant to neuromuscular blocking agents, Allergy, 2017;72:813-819,10.1111/all.13081

	Dong S, Acouetey DS, Guéant-Rodriguez R-M, Zmirou-Navier D, Rémen T, Blanca M, Mertes PM, Guéant J-L, Prevalence of IgE against neuromuscular blocking agents in hairdressers and bakers, Clin Exp Allergy, 2013;43:1256-1262,

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