Intolerance reaction K90.4; T88.7

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Pseudoallergic reaction; Pseudoallergy; Pseudo-Allergy; Reaction pseudoallergic

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Acute or chronic, non-immunological, dose-dependent, biological reaction form that mimics an allergic reaction and has no relation to pharmacological toxicity in the case of triggering drugs. Enzymatically triggered reactions such as lactose intolerance or ACE-induced angioedema are also considered intolerance reactions.

Frequently triggered by drugs, e.g. salicylates ( urticaria, intolerance urticaria), food preservatives and dyes or biogenic amines (see also immunological drug reactions).

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Mechanisms and causes of intolerance reactions:

  • Mediator release from mast cells: tartrazine (?), antibiotics, muscle relaxants, opioids.
  • Influence on the metabolism of arachidonic acid: X-ray contrast media, analgesics (e.g. salicylates), anti-inflammatory drugs, food dyes (?), benzoates(?), parabens (?).
  • Complement activation: immunoglobulin aggregates, X-ray contrast agent, protamine.
  • Kinin activation: local anesthetics, ACE inhibitors.
  • Lymphocyte activation: ampicillin, hydantoin.
  • Release of neurotransmitters: erythrosine, glutamate.
  • Excitation of autonomic receptors: sulphites, glutamate, local anaesthetics
  • Activation of the MRGPRX2 receptor (plays a role in the intolerance reaction to ciprofloxacin)

Clinical features
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Possible symptoms include chronic urticaria, anaphylactic shock, angioedema, gastrointestinal complaints and respiratory tract symptoms ranging from rhinitis to asthma attacks.

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  1. Ring J et al (2018) Immediate type allergy: Rhinoconjunctivitis, bronchial asthma, anaphylaxis. In: Braun-Falco`s Dermatology, Venerology Allergology G. Plewig et al. (Hrsg) Springer Verlag S 454


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020