Sugammadex hypersensitivity and underlying mechanisms: a randomised study of healthy non-anaesthetised volunteers

P. J. de Kam, H. Nolte, S. Good, M. Yunan, D. E. Williams-Herman, J. Burggraaf, C. Kluft, N. F. Adkinson, C. Cullen, P. S. Skov, J. H. Levy, D. J. van den Dobbelsteen, E. L.G.M. van Heumen, F. C.M. van Meel, D. Glassner, T. Woo, K. C. Min, P. A.M. Peeters

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background: We investigated potential for hypersensitivity reactions after repeated sugammadex administration and explored the mechanism of hypersensitivity. Methods: In this double-blind, placebo-controlled study (NCT00988065), 448 healthy volunteers were randomised to one of three arms to receive three repeat i.v. administrations of either sugammadex 4 mg kg−1, 16 mg kg−1, or placebo. Primary endpoint was percentage of subjects with hypersensitivity (assessed by an independent adjudication committee). Secondary endpoint of anaphylaxis was classified per Sampson and Brighton criteria. Exploratory endpoints included skin testing, serum tryptase, anti-sugammadex antibodies [immunoglobulin (Ig) E/IgG], and other immunologic parameters. Results: Hypersensitivity was adjudicated for 1/148 (0.7%), 7/150 (4.7%), and 0/150 (0.0%) subjects after sugammadex 4 mg kg−1, 16 mg kg−1, and placebo, respectively. After sugammadex 16 mg kg−1, one subject met Sampson criterion 1 and Brighton level 1 (highest certainty) anaphylaxis criteria; two met Brighton level 2 criteria. After database lock it was determined that certain protocol deviations could have introduced bias in the reporting of hypersensitivity signs/symptoms in a subject subset. Objective laboratory investigations indicated that potential underlying hypersensitivity mechanisms were unlikely to have been activated; the results suggest that most of the observed hypersensitivity reactions were unlikely IgE/IgG-mediated. Conclusion: Dose-dependent hypersensitivity or anaphylaxis reactions to sugammadex were observed when administered without prior neuromuscular blocking agent. Laboratory investigations do not suggest prevalent allergen-specific IgE/IgG-mediated immunologic hypersensitivity. Because it could not be fully excluded that estimates of hypersensitivity/anaphylaxis incidence were unbiased, an additional study was conducted to characterise the potential for hypersensitivity reactions and is described in a companion report. Clinical trial registration: NCT00988065; Protocol number P06042.

Original languageEnglish (US)
Pages (from-to)758-767
Number of pages10
JournalBritish journal of anaesthesia
Issue number4
StatePublished - Oct 2018


  • anaphylaxis
  • hypersensitivity
  • sugammadex

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


Dive into the research topics of 'Sugammadex hypersensitivity and underlying mechanisms: a randomised study of healthy non-anaesthetised volunteers'. Together they form a unique fingerprint.

Cite this