Rocuronium: high risk for anaphylaxis

Patients suspected of anaphylaxis during anaesthesia have been referred to the senior author's clinic since 1974 for investigation. Since release of r ocuronium on to the worldwide market, concern has been expressed about its propensity to cause anaphylaxis. We identified 24 patients who met clinical and laboratory (intradermal, mast cell tryptase and morphine radioimmunoas say) criteria for anaphylaxis to rocuronium. The incidence of rocuronium al lergy in New South Wales, Australia has risen in pal allel with sales, whil e there has been an associated fail in reactions to other neuromuscular blo cking drugs. Data from intradermal testing suggested that rocuronium is int ermediate in its propensity to cause allergy in known relaxant reactors com pared with low-risk agents (e.g, pancuronium, vecuronium) and higher-risk a gents (e.g. alcuronium, succinylcholine).