Drugs which exacerbate the symptoms of anaphylaxis by nonimmunologic mast cell activation

Q:  All of the following can exacerbate the symptoms of anaphylaxis by causing nonimmunologic mast cell activation except?

A) ethanol
B) nonsteroidal anti-inflammatory drugs (NSAIDs)
C) opiates
D) ACE inhibitors


Answer: D

There are several groups of drugs that can make symptoms of anaphylaxis worse but they all have a different mechanism of actions (MOAs). 

Ethanol, NSAIDs, and opiates (choices A, B, and C) exacerbate anaphylaxis by causing nonimmunologic mast cell activation. ACE inhibitors block the effect of angiotensin, a compensatory response, and block the degradation of kinins, which are active in the production of symptoms and signs (choice D).  

Beta-blockers can potentially make anaphylaxis difficult to treat, and Alpha-blockers may decrease the effects of endogenous or exogenous epinephrine.

#anaphylaxis
#pharmacology


References:

1. Simons FE. Anaphylaxis. J Allergy Clin Immunol 2010; 125:S161. 

2. Mueller UR. Cardiovascular disease and anaphylaxis. Curr Opin Allergy Clin Immunol 2007; 7:337.