{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T13:57:17Z","timestamp":1776866237060,"version":"3.51.2"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,5]],"date-time":"2021-06-05T00:00:00Z","timestamp":1622851200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,5]],"date-time":"2021-06-05T00:00:00Z","timestamp":1622851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["18K08809"],"award-info":[{"award-number":["18K08809"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["20K17803"],"award-info":[{"award-number":["20K17803"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Sugammadex is a synthetic \u03b3-cyclodextrin derivative designed to selectively bind to steroidal neuromuscular blocking agents and reverse their effects. Although many cases of sugammadex-induced anaphylaxis have been reported, few studies have investigated the underlying mechanism.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 55-year-old Japanese man underwent a laryngectomy under general anesthesia. One month before laryngectomy, he had undergone laryngoscopy under general anesthesia and received sugammadex administration without causing hypersensitivity. He had no history of allergies. The operation was finished without complications. Shortly after sugammadex administration, his blood pressure dropped to approximately 70\u00a0mmHg, and his heart rate increased to 110\u00a0beats\/minute with systemic erythema. Suspecting anaphylaxis, he was treated with the intravenous injection of phenylephrine, <jats:sc>d<\/jats:sc>-chlorpheniramine, and hydrocortisone. After these treatments, his cardiovascular condition stabilized. Eight months after the event, skin prick tests and intradermal tests with all agents used during general anesthesia were performed. Intradermal tests showed positive results only for sugammadex. Subsequently, basophil activation tests with CD203c were performed using sugammadex, \u03b3-cyclodextrin, and positive controls (anti-immunoglobulin-E and formyl-methionyl-leucyl-phenylalanine). In addition to both controls, sugammadex, but not \u03b3-cyclodextrin, induced significant upregulation of CD203c expression. We performed additional basophil activation tests with wortmannin, an inhibitor of phosphoinositide 3-kinase, to investigate the mechanism underlying sugammadex-induced basophil activation. The inhibitory effect of wortmannin on basophil activation due to sugammadex was similar to that of anti-immunoglobulin-E, suggesting an immunoglobulin-E-dependent mechanism. Although the patient showed no hypersensitivity after the first exposure of sugammadex, anaphylaxis appeared after the second administration. Because most cases of sugammadex-induced anaphylaxis reportedly appeared after first administration, this seems to be a rare case.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>In the present case, sugammadex-induced anaphylaxis might have occurred through an immunoglobulin-E-dependent mechanism and not involve \u03b3-cyclodextrin as an epitope. Physicians should pay attention to the occurrence of sugammadex-induced anaphylaxis even when the patient has a history of safe administration of sugammadex.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-021-02894-3","type":"journal-article","created":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T23:07:43Z","timestamp":1622848063000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Possible immunoglobulin-E-dependent sugammadex-induced anaphylaxis caused by an epitope other than \u03b3-cyclodextrin: a case report"],"prefix":"10.1186","volume":"15","author":[{"given":"Tatsuo","family":"Horiuchi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0119-3532","authenticated-orcid":false,"given":"Tomonori","family":"Takazawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinya","family":"Sakamoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaki","family":"Orihara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akihiko","family":"Yokohama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mutsumi","family":"Uchiyama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigeru","family":"Saito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,6,5]]},"reference":[{"issue":"5","key":"2894_CR1","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1007\/s00540-020-02836-1","volume":"34","author":"K Suzuki","year":"2020","unstructured":"Suzuki K, Takazawa T, Saito S. History of the development of antagonists for neuromuscular blocking agents. J Anesth. 2020;34(5):723\u20138.","journal-title":"J Anesth."},{"issue":"2","key":"2894_CR2","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1007\/s00540-015-2105-x","volume":"30","author":"T Takazawa","year":"2016","unstructured":"Takazawa T, Mitsuhata H, Mertes PM. Sugammadex and rocuronium-induced anaphylaxis. J Anesth. 2016;30(2):290\u20137.","journal-title":"J Anesth."},{"issue":"2","key":"2894_CR3","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.bja.2019.10.016","volume":"124","author":"M Orihara","year":"2020","unstructured":"Orihara M, Takazawa T, Horiuchi T, Sakamoto S, Nagumo K, Tomita Y, et\u00a0al. Comparison of incidence of anaphylaxis between sugammadex and neostigmine: a retrospective multicentre observational study. Br J Anaesth Br J Anaesth. 2020;124(2):154\u201363.","journal-title":"Br J Anaesth. Br J Anaesth."},{"issue":"3","key":"2894_CR4","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1016\/j.alit.2016.02.013","volume":"65","author":"E Hotta","year":"2016","unstructured":"Hotta E, Tamagawa-Mineoka R, Masuda K, Taura M, Nakagawa Y, Kanehisa F, et\u00a0al. Anaphylaxis caused by gamma-cyclodextrin in sugammadex. Allergol Int. 2016;65(3):356\u20138.","journal-title":"Allergol Int."},{"issue":"4","key":"2894_CR5","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.1016\/j.jaip.2019.11.018","volume":"8","author":"DG Ebo","year":"2020","unstructured":"Ebo DG, Baldo BA, Van Gasse AL, Mertens C, Elst J, Sermeus L, et\u00a0al. Anaphylaxis to sugammadex-rocuronium inclusion complex: an IgE-mediated reaction due to allergenic changes at the sugammadex primary rim. J Allergy Clin Immunol Pract. 2020;8(4):1410\u20135.","journal-title":"J Allergy Clin Immunol Pract."},{"issue":"7","key":"2894_CR6","doi-asserted-by":"publisher","first-page":"2457","DOI":"10.1016\/j.jaip.2020.04.049","volume":"8","author":"M Orihara","year":"2020","unstructured":"Orihara M, Nagumo K, Takazawa T. Does sugammadex have multiple mechanisms for causing anaphylaxis? J Allergy Clin Immunol Pract. 2020;8(7):2457\u20138.","journal-title":"J Allergy Clin Immunol Pract."},{"key":"2894_CR7","doi-asserted-by":"publisher","first-page":"1509","DOI":"10.1213\/ANE.0000000000002879","volume":"126","author":"T Horiuchi","year":"2018","unstructured":"Horiuchi T, Yokohama A, Orihara M, Tomita Y, Tomioka A, Yoshida N, et\u00a0al. Usefulness of basophil activation tests for diagnosis of sugammadex-induced anaphylaxis. Anesth Analg. 2018;126:1509\u201316.","journal-title":"Anesth Analg."},{"key":"2894_CR8","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1007\/s40521-020-00248-w","volume":"7","author":"BA Baldo","year":"2020","unstructured":"Baldo BA. Perioperative reactions to sugammadex. Curr Treat Options Allergy. 2020;7:43\u201363.","journal-title":"Curr Treat Options Allergy."},{"issue":"12","key":"2894_CR9","doi-asserted-by":"publisher","first-page":"7027","DOI":"10.4049\/jimmunol.167.12.7027","volume":"167","author":"K Miura","year":"2001","unstructured":"Miura K, Lavens-Phillips S, MacGlashan DW Jr. Localizing a control region in the pathway to leukotriene C(4) secretion following stimulation of human basophils with anti-IgE antibody. 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Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"313"}}