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Department of Anesthesiology Department of Pharmacy, Albert Einstein Medical Center, Philadelphia, PA
To the Editor:
Drs. Hepner and Castells remind us that immediate discontinuation of the offending agent and epinephrine administration are the cornerstones of treating anaphylaxis (1). However, this may present a problem in the patient with a sulfite allergy. Sodium metabisulfite (MBS) is a commonly used food and drug preservative. In particular, according to Drug Facts and Comparisons (a standard pharmacy reference published by Wolters Kluwer and updated monthly), every commercially available preparation of epinephrine contains MBS. In addition to reports of bronchospasm, urticaria, angioedema, nausea, abdominal pain, diarrhea, seizures, and death, anaphylactic and anaphylactoid reactions to sulfites have been documented (26). Of particular note, anaphylactoid shock occurred during epidural anesthesia for cesarean delivery in which the responsible agent was metabisulfite, an additive agent of the epinephrine containing local anesthetic (5).
Thus we would like to ask what options exist for treating anaphylaxis to either MBS or another medication in the sulfite allergic patient, since epinephrine contains MBS. Additionally, is it possible to desensitize a patient to MBS, and if so, how long does it take? Is "quick" desensitization possible for the emergent situation, and how effective and long lasting is the desensitization for the prevention of anaphylaxis to MBS?
References
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