Intolerance reaction K90.4; T88.7

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).

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)

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