{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T16:39:00Z","timestamp":1790008740151,"version":"4.0.1"},"reference-count":34,"publisher":"American Dental Society of Anesthesiology (ADSA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>We report a rare case of anaphylaxis triggered by a third exposure to sugammadex. The patient was a 49-year-old man who had previously been exposed to sugammadex on two occasions and then developed likely anaphylaxis (severe hypotension and skin, gastrointestinal, and respiratory symptoms) after administration of sugammadex following bilateral mandibular alveoloplasty. He was promptly and successfully managed and recovered fully without any complications. A subsequent sugammadex drug-induced lymphocyte stimulation test was negative. The mechanism via which sugammadex causes anaphylaxis is not well understood. In recent years, there have been reports implicating the rocuronium\u2013sugammadex complex as a cause of anaphylaxis, but some of those cases did not include a positive allergic reaction to sugammadex alone. We suspected that the rocuronium\u2013sugammadex complex might have been the causative agent in this case. Our experience suggests there may be a significant risk of anaphylaxis even in patients who have been exposed to sugammadex safely on previous occasions. The need for sugammadex should be assessed carefully using a muscle relaxation monitor, and providers must remain vigilant for anaphylaxis after administration of sugammadex.<\/jats:p>","DOI":"10.2344\/24-0013","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T05:08:16Z","timestamp":1749445696000},"page":"95-99","source":"Crossref","is-referenced-by-count":2,"title":["Anaphylaxis After a Third Exposure to Sugammadex"],"prefix":"10.2344","volume":"72","author":[{"given":"Honoka","family":"Ishihara","sequence":"first","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukie","family":"Nitta","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoko","family":"Kudo","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanta","family":"Kido","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1191","reference":[{"key":"i1878-7177-72-2-95-b01","series-title":"Anesthesiology","first-page":"100","article-title":"Perioperative anaphylaxis","volume":"138","author":"Tacquard C","year":"2023","unstructured":"Tacquard C,\nIba T,\nLevy JH. Perioperative anaphylaxis. Anesthesiology 2023;138:100\u2013110."},{"key":"i1878-7177-72-2-95-b02","series-title":"A A Pract","first-page":"e01725","article-title":"Sugammadex-induced anaphylactic shock reversed with short-term continuous veno-venous hemodiafiltration: a case report","volume":"17","author":"Dichtwald S","year":"2023","unstructured":"Dichtwald S,\nMeyer A,\nMiller Y,\nMirit L. Sugammadex-induced anaphylactic shock reversed with short-term continuous veno-venous hemodiafiltration: a case report. A A Pract. 2023;17:e01725."},{"key":"i1878-7177-72-2-95-b03","series-title":"J Anesth","first-page":"154","article-title":"Drug-induced anaphylaxis during general anesthesia in 14 tertiary hospitals in Japan: a retrospective, multicenter, observational study","volume":"35","author":"Horiuchi T","year":"2021","unstructured":"Horiuchi T,\nTakazawa T,\nOrihara M,\nSakamoto S,\nNagumo K,\nSaito S. Drug-induced anaphylaxis during general anesthesia in 14 tertiary hospitals in Japan: a retrospective, multicenter, observational study. J Anesth. 2021;35:154\u2013160."},{"key":"i1878-7177-72-2-95-b04","series-title":"J Clin Anesth","first-page":"1","article-title":"Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials","volume":"35","author":"Carron M","year":"2016","unstructured":"Carron M,\nZarantonello F,\nTellaroli P,\nOri C. Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials. J Clin Anesth. 2016;35:1\u201312."},{"key":"i1878-7177-72-2-95-b05","series-title":"Br J Anaesth","first-page":"694","article-title":"Sugammadex: the sting in the tail","volume":"121","author":"Savic L","year":"2018","unstructured":"Savic L,\nSavic S,\nHopkins PM. Sugammadex: the sting in the tail? Br J Anaesth. 2018;121:694\u2013697."},{"key":"i1878-7177-72-2-95-b06","series-title":"Expert Opin Drug Saf","first-page":"883","article-title":"Safety of sugammadex for reversal of neuromuscular block","volume":"18","author":"Honing G","year":"2019","unstructured":"Honing G,\nMartini CH,\nBom A, et al. Safety of sugammadex for reversal of neuromuscular block. Expert Opin Drug Saf. 2019;18:883\u2013891."},{"key":"i1878-7177-72-2-95-b07","series-title":"Br J Anaesth","first-page":"159","article-title":"Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6)","volume":"121","author":"Harper NJN","year":"2018","unstructured":"Harper NJN,\nCook TM,\nGarcez T, et al. Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6). Br J Anaesth. 2018;121:159\u2013171."},{"key":"i1878-7177-72-2-95-b08","series-title":"Br J Anaesth","first-page":"154","article-title":"Comparison of incidence of anaphylaxis between sugammadex and neostigmine: a retrospective multicentre observational study","volume":"124","author":"Orihara M","year":"2020","unstructured":"Orihara M,\nTakazawa T,\nHoriuchi T, et al. Comparison of incidence of anaphylaxis between sugammadex and neostigmine: a retrospective multicentre observational study. Br J Anaesth. 2020;124:154\u2013163."},{"key":"i1878-7177-72-2-95-b09","series-title":"J Anaesthesiol Clin Pharmacol","first-page":"360","article-title":"Sugammadex-induced anaphylactic reaction: a systematic review","volume":"38","author":"Zecic F","year":"2022","unstructured":"Zecic F,\nSmart MH,\nAbbey TC,\nPazhempallil A,\nKorban C. Sugammadex-induced anaphylactic reaction: a systematic review. J Anaesthesiol Clin Pharmacol. 2022;38:360\u2013370."},{"key":"i1878-7177-72-2-95-b10","series-title":"Anaesthesia","first-page":"1251","article-title":"Hypersensitivity associated with sugammadex administration: a systematic review","volume":"69","author":"Tsur A","year":"2014","unstructured":"Tsur A,\nKalansky A. Hypersensitivity associated with sugammadex administration: a systematic review. Anaesthesia 2014;69:1251\u20131257."},{"key":"i1878-7177-72-2-95-b11","series-title":"Anesth Analg","first-page":"1505","article-title":"Incidence of anaphylaxis associated with sugammadex","volume":"126","author":"Miyazaki Y","year":"2018","unstructured":"Miyazaki Y,\nSunaga H,\nKida K, et al. Incidence of anaphylaxis associated with sugammadex. Anesth Analg. 2018;126:1505\u20131508."},{"key":"i1878-7177-72-2-95-b12","series-title":"Anesthesiology","first-page":"1141","article-title":"Anaphylaxis and anesthesia: controversies and new insights","volume":"111","author":"Dewachter P","year":"2009","unstructured":"Dewachter P,\nMouton-Faivre C,\nEmala CW. Anaphylaxis and anesthesia: controversies and new insights. Anesthesiology 2009;111:1141\u20131150."},{"key":"i1878-7177-72-2-95-b13","series-title":"J Anesth","first-page":"148","article-title":"A suspected case of rocuronium-sugammadex complex-induced anaphylactic shock after cesarean section","volume":"31","author":"Yamaoka M","year":"2017","unstructured":"Yamaoka M,\nDeguchi M,\nNinomiya K,\nKurasako T,\nMatsumoto M. A suspected case of rocuronium-sugammadex complex-induced anaphylactic shock after cesarean section. J Anesth 2017;31:148\u2013151."},{"key":"i1878-7177-72-2-95-b14","series-title":"A A Case Rep","first-page":"190","article-title":"The first case report of anaphylaxis caused by the inclusion complex of rocuronium and sugammadex","volume":"7","author":"Ho G","year":"2016","unstructured":"Ho G,\nClarke RC,\nSadleir PH,\nPlatt PR. The first case report of anaphylaxis caused by the inclusion complex of rocuronium and sugammadex. A A Case Rep. 2016;7:190\u2013192."},{"key":"i1878-7177-72-2-95-b15","series-title":"Br J Anaesth","first-page":"e50\u201364","article-title":"Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations","volume":"123","author":"Garvey LH","year":"2019","unstructured":"Garvey LH,\nDewachter P,\nHepner DL, et al. Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations. Br J Anaesth. 2019;123:e50\u201364."},{"key":"i1878-7177-72-2-95-b16","series-title":"Resuscitation","first-page":"86","article-title":"Evidence update for the treatment of anaphylaxis","volume":"163","author":"Dodd A","year":"2021","unstructured":"Dodd A,\nHughes A,\nSargant N,\nWhyte AF,\nSoar J,\nTurner PJ. Evidence update for the treatment of anaphylaxis. Resuscitation 2021;163:86\u201396."},{"key":"i1878-7177-72-2-95-b17","series-title":"Core Evidence","first-page":"57","article-title":"Sugammadex as a reversal agent for neuromuscular block: an evidence-based review","volume":"8","author":"Schaller SJ","year":"2012","unstructured":"Schaller SJ,\nFink H. Sugammadex as a reversal agent for neuromuscular block: an evidence-based review. Core Evidence 2012;8:57\u201367."},{"key":"i1878-7177-72-2-95-b01","series-title":"Anesthesiology","first-page":"100","article-title":"Perioperative anaphylaxis","volume":"138","author":"Tacquard C","year":"2023","unstructured":"Tacquard C,\nIba T,\nLevy JH. Perioperative anaphylaxis. Anesthesiology 2023;138:100\u2013110."},{"key":"i1878-7177-72-2-95-b02","series-title":"A A Pract","first-page":"e01725","article-title":"Sugammadex-induced anaphylactic shock reversed with short-term continuous veno-venous hemodiafiltration: a case report","volume":"17","author":"Dichtwald S","year":"2023","unstructured":"Dichtwald S,\nMeyer A,\nMiller Y,\nMirit L. Sugammadex-induced anaphylactic shock reversed with short-term continuous veno-venous hemodiafiltration: a case report. A A Pract. 2023;17:e01725."},{"key":"i1878-7177-72-2-95-b03","series-title":"J Anesth","first-page":"154","article-title":"Drug-induced anaphylaxis during general anesthesia in 14 tertiary hospitals in Japan: a retrospective, multicenter, observational study","volume":"35","author":"Horiuchi T","year":"2021","unstructured":"Horiuchi T,\nTakazawa T,\nOrihara M,\nSakamoto S,\nNagumo K,\nSaito S. Drug-induced anaphylaxis during general anesthesia in 14 tertiary hospitals in Japan: a retrospective, multicenter, observational study. J Anesth. 2021;35:154\u2013160."},{"key":"i1878-7177-72-2-95-b04","series-title":"J Clin Anesth","first-page":"1","article-title":"Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials","volume":"35","author":"Carron M","year":"2016","unstructured":"Carron M,\nZarantonello F,\nTellaroli P,\nOri C. Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials. J Clin Anesth. 2016;35:1\u201312."},{"key":"i1878-7177-72-2-95-b05","series-title":"Br J Anaesth","first-page":"694","article-title":"Sugammadex: the sting in the tail","volume":"121","author":"Savic L","year":"2018","unstructured":"Savic L,\nSavic S,\nHopkins PM. Sugammadex: the sting in the tail? Br J Anaesth. 2018;121:694\u2013697."},{"key":"i1878-7177-72-2-95-b06","series-title":"Expert Opin Drug Saf","first-page":"883","article-title":"Safety of sugammadex for reversal of neuromuscular block","volume":"18","author":"Honing G","year":"2019","unstructured":"Honing G,\nMartini CH,\nBom A, et al. Safety of sugammadex for reversal of neuromuscular block. Expert Opin Drug Saf. 2019;18:883\u2013891."},{"key":"i1878-7177-72-2-95-b07","series-title":"Br J Anaesth","first-page":"159","article-title":"Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6)","volume":"121","author":"Harper NJN","year":"2018","unstructured":"Harper NJN,\nCook TM,\nGarcez T, et al. Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6). Br J Anaesth. 2018;121:159\u2013171."},{"key":"i1878-7177-72-2-95-b08","series-title":"Br J Anaesth","first-page":"154","article-title":"Comparison of incidence of anaphylaxis between sugammadex and neostigmine: a retrospective multicentre observational study","volume":"124","author":"Orihara M","year":"2020","unstructured":"Orihara M,\nTakazawa T,\nHoriuchi T, et al. Comparison of incidence of anaphylaxis between sugammadex and neostigmine: a retrospective multicentre observational study. Br J Anaesth. 2020;124:154\u2013163."},{"key":"i1878-7177-72-2-95-b09","series-title":"J Anaesthesiol Clin Pharmacol","first-page":"360","article-title":"Sugammadex-induced anaphylactic reaction: a systematic review","volume":"38","author":"Zecic F","year":"2022","unstructured":"Zecic F,\nSmart MH,\nAbbey TC,\nPazhempallil A,\nKorban C. Sugammadex-induced anaphylactic reaction: a systematic review. J Anaesthesiol Clin Pharmacol. 2022;38:360\u2013370."},{"key":"i1878-7177-72-2-95-b10","series-title":"Anaesthesia","first-page":"1251","article-title":"Hypersensitivity associated with sugammadex administration: a systematic review","volume":"69","author":"Tsur A","year":"2014","unstructured":"Tsur A,\nKalansky A. Hypersensitivity associated with sugammadex administration: a systematic review. Anaesthesia 2014;69:1251\u20131257."},{"key":"i1878-7177-72-2-95-b11","series-title":"Anesth Analg","first-page":"1505","article-title":"Incidence of anaphylaxis associated with sugammadex","volume":"126","author":"Miyazaki Y","year":"2018","unstructured":"Miyazaki Y,\nSunaga H,\nKida K, et al. Incidence of anaphylaxis associated with sugammadex. Anesth Analg. 2018;126:1505\u20131508."},{"key":"i1878-7177-72-2-95-b12","series-title":"Anesthesiology","first-page":"1141","article-title":"Anaphylaxis and anesthesia: controversies and new insights","volume":"111","author":"Dewachter P","year":"2009","unstructured":"Dewachter P,\nMouton-Faivre C,\nEmala CW. Anaphylaxis and anesthesia: controversies and new insights. Anesthesiology 2009;111:1141\u20131150."},{"key":"i1878-7177-72-2-95-b13","series-title":"J Anesth","first-page":"148","article-title":"A suspected case of rocuronium-sugammadex complex-induced anaphylactic shock after cesarean section","volume":"31","author":"Yamaoka M","year":"2017","unstructured":"Yamaoka M,\nDeguchi M,\nNinomiya K,\nKurasako T,\nMatsumoto M. A suspected case of rocuronium-sugammadex complex-induced anaphylactic shock after cesarean section. J Anesth 2017;31:148\u2013151."},{"key":"i1878-7177-72-2-95-b14","series-title":"A A Case Rep","first-page":"190","article-title":"The first case report of anaphylaxis caused by the inclusion complex of rocuronium and sugammadex","volume":"7","author":"Ho G","year":"2016","unstructured":"Ho G,\nClarke RC,\nSadleir PH,\nPlatt PR. The first case report of anaphylaxis caused by the inclusion complex of rocuronium and sugammadex. A A Case Rep. 2016;7:190\u2013192."},{"key":"i1878-7177-72-2-95-b15","series-title":"Br J Anaesth","first-page":"e50\u201364","article-title":"Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations","volume":"123","author":"Garvey LH","year":"2019","unstructured":"Garvey LH,\nDewachter P,\nHepner DL, et al. Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations. Br J Anaesth. 2019;123:e50\u201364."},{"key":"i1878-7177-72-2-95-b16","series-title":"Resuscitation","first-page":"86","article-title":"Evidence update for the treatment of anaphylaxis","volume":"163","author":"Dodd A","year":"2021","unstructured":"Dodd A,\nHughes A,\nSargant N,\nWhyte AF,\nSoar J,\nTurner PJ. Evidence update for the treatment of anaphylaxis. Resuscitation 2021;163:86\u201396."},{"key":"i1878-7177-72-2-95-b17","series-title":"Core Evidence","first-page":"57","article-title":"Sugammadex as a reversal agent for neuromuscular block: an evidence-based review","volume":"8","author":"Schaller SJ","year":"2012","unstructured":"Schaller SJ,\nFink H. Sugammadex as a reversal agent for neuromuscular block: an evidence-based review. Core Evidence 2012;8:57\u201367."}],"container-title":["Anesthesia Progress"],"original-title":[],"link":[{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/view\/journals\/anpr\/72\/2\/article-p95.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/downloadpdf\/journals\/anpr\/72\/2\/article-p95.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/downloadpdf\/journals\/anpr\/72\/2\/article-p95.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T02:20:07Z","timestamp":1779848407000},"score":1,"resource":{"primary":{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/view\/journals\/anpr\/72\/2\/article-p95.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":34,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.2344\/24-0013","relation":{},"ISSN":["1878-7177","0003-3006"],"issn-type":[{"value":"1878-7177","type":"electronic"},{"value":"0003-3006","type":"print"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}